TN 30 (03-96)

NL 00703.623 Ineligible for HI/SMI Coverage Because DIB Ceased

Document Identifier for Word Processor: E3623

A. EXHIBIT LETTER

The law provides that an individual's disability shall end if his/her condition improves so that he/she becomes able to do substantial gainful work. The medical evidence in your case shows that your condition has so improved. Therefore, your entitlement to a disability-based benefit ends (1) .

Since you are no longer entitled to a disability-based benefit, you are no longer eligible for health insurance coverage. Please disregard our previous notice to you regarding such coverage.

The ending of your disability-based benefit entitlement and health insurance eligibility has no effect on your entitlement to (2) benefits.

If you believe that this determination is not correct, you may request that your claim be reexamined. If you want this reconsideration, you must request it not later than 60 days from the date you receive this notice. You may make any such request through any Social Security office. If additional evidence is available, you should submit it with your request.

 

If You Have Any Questions

 

3901C

B. REQUESTING INSTRUCTIONS

This notice is used when notifying a deemed DWB of ineligibility for HI/SMI coverage because DIB ceased.

 

Fill-ins:

  1. month and year DIB ends

  2. type of benefit

Refer to NL 00703.005E. for text of 3901C.

C. TYPING INSTRUCTIONS

Information for this letter will be shown on Form SSA-573. The name and address, if not given, can be taken from the latest Form SSA-3926-EP in file.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703623
NL 00703.623 - Ineligible for HI/SMI Coverage Because DIB Ceased - 03/04/1996
Batch run: 01/27/2009
Rev:03/04/1996