TN 22 (03-07)

HI 01005.010 Premium Increase for Delay in Enrollment

A. Policy

1. Surcharge Percentage

Before 7/86, the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) surcharges (increases for late enrollment) were determined the same way. Effective 7/86, the HI surcharge percentage is 10 percent for those who delayed enrollment for 12 months or more, counting the months as described in HI 01005.010B.

2. 2001 Surcharge Amounts

Since the HI premium rates for 2001 are $300.00 (standard) and $165.00 (reduced), the surcharge amounts payable for 2001 are $30.00 (10 percent of the standard HI premium) and $16.50 (10 percent of the reduced HI premium). The total HI premium payable during 2001 for those who must pay a surcharge is either $330.00 (standard HI premium plus the 10 percent surcharge) or $181.50 (reduced HI premium plus the 10 percent surcharge).

3. Surcharge Is Removed

The HI surcharge exists only for a period equal to twice the number of months in each full 12-month period during which the individual could have been, but was not, enrolled in Premium-HI. Thus, some individuals who start 1994 with a surcharge will have the surcharge removed by the end of the year.

NOTE: The number of months in excess of 12 does not, as in SMI, determine the percentage to be assessed as the surcharge.

4. No Effect on SMI Surcharge

The SMI premium surcharge is determined independently from the Premium-HI surcharge, following the instructions in HI 01001.010.

An individual may have to pay only a 10 percent surcharge for Premium-HI but a higher surcharge for SMI. When the Premium-HI surcharge has ended, the individual must continue to pay the SMI surcharge.

5. Surcharge Rules Do Not Apply to Disabled

The surcharge rules discussed above do not apply to Premium-HI for the working disabled.

B. Procedure

Count the months during which an individual could have been but was not enrolled in Premium-HI. Exclude from the total certain months as provided by law.

1. Count These Months

  1. Count the months after the end of the initial enrollment period (IEP) through the end of the enrollment period in which enrollment occurs, i.e., the general enrollment period (GEP), the special enrollment period (SEP) described in HI 00805.265, the SEP for International Volunteers described in HI00805.350, or the transfer enrollment period.

  2. For those who enroll more than once, add to HI 01005.010B.1.a. the number of months elapsed between termination of each coverage period and the close of each enrollment period in which the individual enrolled.

2. Exclude These Months

From the total countable months in HI 01005.010B.1.:

  1. Exclude any months prior to 9/73, if the Premium-HI initial enrollment period ended prior to that date;

  2. Exclude any months, as explained in HI 01001.010B.1., relating to enrollments during the open enrollment period of 4/81-9/81;

  3. Exclude any months affected by the (repealed) 2-enrollment limitation, as explained in HI 01001.010B.2. and HI 01001.011E.;

  4. Exclude any months beginning with 1/83 in which the individual was age 65 or over and covered under a group health plan as described in HI 00805.265 and HI 00805.740;

  5. For premiums effective with 2/91, exclude any months of enrollment by an individual age 65 or over in a Medicare+Choice plan that meets the definition in HI 00208.066, as described in HI 00801.142C.4.

  6. For premiums due 1/2007 and later, exclude all months the individual was serving as a volunteer outside of the United States for a tax exempt organization and had health insurance that provided coverage while he/she was outside of the United States. See HI 00805.365.