Identification Number:
HI 00805 TN 30
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Supplementary Medical Insurance Entitlement
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 008 – Requirement for Entitlement and Termination
Subchapter 05 – Supplementary Medical Insurance Entitlement
Transmittal No. 30, 01/15/2019

Audience

PSC: BET, BTE, CR, CST, CTE, DEC, EHI, LCC, PAS, PCS, PETL, RECONR;
OCO-OEIO: BET, BIES, CCRE, CR, CTE, EIE, ERE, FCR, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CR, CST, CTE, CTE TE, DEC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal- no change to or introduction of new policy or procedure.

Summary of Changes

HI 00805.130 When an Enrollment Received by Mail Is Considered Filed

Modify language by adding "EXCEPTION" paragraph.

HI 00805.130 When an Enrollment Received by Mail Is Considered Filed

A. Policy

1. Filing based on postmark

Enrollments made through the mail are considered filed when deposited in the U.S. mail, if this is advantageous to the enrollee (i.e., when this allows the individual to be enrolled during a certain month but the actual date of receipt would not).

2. Delay in mail

The date of deposit will ordinarily be the postmark date. However, a filing date may be established up to 2 days earlier than the postmark where there is an identifiable delay in handling of mail in the United States Postal Service. Verification of such delay from postal authorities is not normally needed.

A filing date earlier than 2 days prior to postmark may be established based on a credible statement from the enrollee which is not contradicted by other evidence (e.g., a date shown on the enrollment request agrees with or precedes the alleged date of deposit).

3. Retain envelope

When enrollments are received through the mails early in the month following the end of the IEP or GEP, the envelope containing the postmark will be retained until the enrollment is finally processed.

4. 7-day tolerance

Enrollments mailed to SSA may have a 7-day tolerance applied to them if the date of filing is material, the postmark is illegible or missing (or the envelope is missing or destroyed), and it originated in the continental United States (other than Alaska).

That is, if an enrollment is received during the first 7 days of the month following the end of an enrollment period (or month - where the month of enrollment is significant), it will be presumed, in the absence of any evidence to the contrary, that the enrollment request was mailed before the end of the enrollment period (or month).

Where the postmark is illegible or missing, and the enrollment request originated in Alaska, Hawaii, Puerto Rico, the Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands, the mailing date is determined on a case-by-case basis.

5. Allegations and tolerances not always used

Despite the above provisions, if the enrollment request is itself dated after the end of the enrollment period (or month, where the month of enrollment is significant), the writing would not be considered filed in the enrollment period (or month).

NOTE: 

This is because it appears that the individual did not attempt to enroll during such enrollment period (or month).

EXCEPTION: 

If an individual requested their enrollment forms in an accessible format during their Initial Enrollment Period (IEP) (such as Braille or an alternative format) and he or she did not receive their enrollment forms in the requested format, their requested can be extended to include the amount of time it took for the individual to receive the enrollment forms in the accessible format.

B. References

  • Mailing dates, GN 00204.007 B.1.

  • Enrollment under State agreements, HI 00815.001ff.


HI 00805 TN 30 - Supplementary Medical Insurance Entitlement - 1/15/2019