TN 68 (09-15)

NL 00703.630 HI/SMI — Government Medicare — Coverage Based on Disability — Coverage Begins More Than 2 Months After Current Operating Month

Document Identifier for Word Processor: E3630

A. Requesting instructions

This notice tells claimants of their allowance for Government (Federal, State, or local) Medicare coverage based on disability when their entitlement date is more than 2 months after the current operation month.

B. Exhibit letter

*F1 *F2 disabled based on Social Security rules. *F3 disability began *F4. You are entitled to Medicare benefits starting *F5, if you are still disabled. You will get *F6 Medicare card and information about those benefits in the mail about 3 months before *F7 coverage starts.

As a government employee, *F8 not qualify for monthly Social Security disability payments.

   

3619A

OR

3619B

OR

3619C

   

BRRC01

During *F1 waiting period for Medicare, you must promptly report the following to Social Security:

  • Change of Address — We will send important notices from time to time.

  • Return to Work — Tell us if *F2 back to work, no matter how little *F3. We have special rules to help *F4 work. *F5 might be eligible for a 9-month trial work period during which *F6 can test *F7 ability to work without losing *F8 Medicare.

  • Medical Improvement — Tell us if *F9 doctor feels *F10 condition has improved so that *F11 can do some work.

   

CLOC01

CLO001 

   

ALSC02

ALS020

   

REPC01

REP001

   

CTDO

C. Exhibit notice fill-ins

3630.1 fill-ins:

*F1-1 You

*F1-2 Beneficiary’s full name

   

*F2-1 are

*F2-2 is

   

*F3-1 Your

*F3-2 His

*F3-3 Her

  

*F4-1 Date of onset

   

*F5-1 Date of Medicare entitlement

   

*F6-1 your

*F6-2 his

*F6-3 her

   

*F7-1 your

*F7-2 his

*F7-3 her

   

*F8-1 you do

*F8-2 he does

*F8-3 she does

   

  • Include 3619A in Medical Improvement Possible cases.

  • Include 3619B in Medical Improvement Not Expected cases.

  • Include 3619C in Medical Improvement Expected cases.

Refer to NL 00703.619 for 3619A, 3619B and 3619C text and fill-in.

3630.2 Fill-ins

*F1-1 your

*F1-2 Beneficiary’s full name

  

*F2-1 you go

*F2-2 he goes

*F2-3 she goes

   

*F3-1 you earn

*F3-2 he earns

*F3-3 she earns

   

*F4-1 you

*F4-2 him

*F4-3 her

   

*F5-1 You

*F5-2 He

*F5-3 She

   

*F6-1 you

*F6-2 he

*F6-3 she

   

*F7-1 your

*F7-2 his

*F7-3 her

   

*F8-1 your

*F8-2 his

*F8-3 her

   

*F9-1 your

*F9-2 his

*F9-3 her

   

*F10-1 your

*F10-2 his

*F10-3 her

   

*F11-1 you

*F11-2 he

*F12-3 she


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703630
NL 00703.630 - HI/SMI -- Government Medicare -- Coverage Based on Disability -- Coverage Begins More Than 2 Months After Current Operating Month - 12/18/2015
Batch run: 12/18/2015
Rev:12/18/2015