Effective Dates: 2/24/2025 - Present

Identification Number:
DI 10105 TN 12
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Insurance Benefits (DIB) and Freeze
Type:POMS Full Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 101 – Disability and Blindness Requirements

Subchapter 05 – Disability Insurance Benefits (DIB) and Freeze

Transmittal No. 12, 02/24/2025

Audience

PSC: BA, CA, CS, DE, DEC, DS, DTE, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, BTE, CCRE, CIES, CR, CTE, ERE, FCR, FDE, FDEC, OAC, PETL, RAC, RECONE, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, CTE TET, DE, DEC, DES, DS, DSE, OAC, PA, PAS, PETE, PETL, RAC, RCOVTA, RECONE, RECOVR;
ODD-DDS: ADJ, DHU, REF;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This transmittal incorporates updates to the 5-month waiting period exclusion policy to include all applicable scenarios and clear instructions on how to waive the waiting period. The policy instructions in this section are for cases involving ALS, also known as Lou Gehrig's disease. Effective July 23, 2020, the 5-month DIB entitlement waiting periods are waived for disabled claimants with ALS.

Summary of Changes

DI 10105.075 When The Five Month Waiting Period Is Not Required

Language and formatting changes were made throughout this entire section to provide updates and clarity. Updated and changed subsection titles to make clearer.

DI 10105.075 When The Five Month Waiting Period Is Not Required

A. Policy

Disability insurance benefit (DIB) claimants will not have to serve a waiting period if they have:

  • •

    A diagnosis of Amyotrophic Lateral Sclerosis (ALS) within the five month waiting period and the Notice of Award date is on or after 07/23/2020 (see DI 11036.001), or

  • •

    a prior period of disability (PPD) (see DI 10105.001 - Period of Disability) that terminated within 5 years (60 months) before the current period of disability began.

REMINDER: There is no 5-month waiting period for childhood disability benefits (CDB) entitlement. For more information on CDB, see DI 10115.001. For disabled widow(er) benefits (DWB) entitlement, supplement security income (SSI) eligibility months may be credited toward both the 5-month waiting period for payments and the 24-month qualifying period for Medicare coverage. For more information on DWB, see DI 10110.001.

NOTE: 

If a Medicare for Qualified Government Employment (MQGE) beneficiary subsequently becomes insured for DIB, the MQGE period is not treated as a prior period of DIB. The deemed waiting period in the MQGE entitlement does not satisfy the requirement for a DIB waiting period, even if MQGE entitlement is continuing when a period of DIB is established. For more information on the DIB waiting period, see DI 10105.070.

B. Entitlement date

When the DIB waiting period does not apply, eligibility for benefits begins with the first month within the effective life of the application:

  • •

    throughout which the claimant is under a disability, and

  • •

    has DIB insured status.

If the claimant does not have DIB insured status in the month the current disability begins, the claimant will not be eligible for a DIB until the first month thereafter in which insured status exists. In these situations, the first day of the first month of the first quarter in which the claimant has insured status for the current period of disability will become the established onset date (EOD).

For more information on DIB insured status requirements, see RS 00301.120. For information on how a period of disability affects insured status, see RS 00301.122.

C. Prior period of disability (PPD) cases

 

1. Beginning date of 60–month period

The 60–month period begins with the month in which DIB terminated or the prior freeze ceased, i.e., the month after the last month of entitlement. The T8 month on the MBR History line or the DBC entry on the DIB line is the first month counted for the 60–month period. For example, if the last payment was for 11/2006. the 60–month period would be 12/2006 through 11/2011.

2. Ending date of 60-month period

The ending date of the 60-month period is the last day of the 60th calendar month after the end of the prior DIB entitlement or the end of the prior freeze period. If a new period of disability is established within the 60–month period mentioned above, the period ends with the month before the first month throughout all of which the NH is under a disability.

Where the current disability begins on the first day of a month, the period will end with the preceding month. If it begins on a day other than the first day of a month, the period will end with the month in which the current disability began.

EXAMPLE: A claimant’s period of disability terminated 11/30/2015 (12/2015 is the T8 month on the MBR History line and the DBC entry on the DIB line) as he was no longer disabled. The 60-month period would be 12/2015 through 11/2020. The claimant filed for a new period of disability on 2/18/2021. The DDS established the claimant was disabled on 8/14/2020. The claimant does not have to serve a waiting period because his new period of disability, the date of onset, falls within the 60-month period. The claimant’s entitlement date would be 09/2020.


DI 10105 TN 12 - Disability Insurance Benefits (DIB) and Freeze - 2/24/2025