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
B. REQUESTING INSTRUCTIONS
This notice is used when notifying a deemed DWB of ineligibility for HI/SMI coverage because DIB ceased.
month and year DIB ends
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.