When a claimant has not paid SMI premiums by the end of the grace period, SMI coverage is terminated.
When an individual alleges he or she made a timely payment and submits evidence (e.g., a cancelled check, a DO receipt, etc.) supporting the allegation, the termination action must be reversed. However, it is imperative that the exception listings are checked prior to reentering the premium data to avoid crediting the record with the same premium payment twice. When there is no indication that an exception exists or that the premium payment has been credited based on a previous inquiry or that a prior action corrected the record, reenter the data based on the supporting evidence by means of Form SSA-1592 (see HI 00820.140).
When an exception is found indicating the premium payment was not accepted for annotation to the MDBQ, expedite the processing of the exception. Inform the claimant that the termination notice was erroneous and that SMI coverage has been reinstated.
When an individual alleges he or she made a timely premium payment and does not submit proof of payment with the allegation, check all available sources to ascertain if a record exists of the remittance. When a record is found, reinstate SMI coverage immediately by either reentering the data or resolving the exception, as applicable.
When no record of the remittance is found, request the DO by means of Form SSA-5075 to secure proof of payment. Keep in mind that due to the public relations problems which can arise, the request for proof of payment should be made only after all records and sources have been thoroughly checked and no record is found.
When an enrollee submits proof of a timely payment, reinstate SMI coverage in accordance with HI 00820.135. The original postmark date must be shown. If the individual is insured or a special age 72 claimant, a debit and credit should be processed in accordance with HI 00820.140 to reinstate SMI coverage due to the receipt of a timely remittance.
When the individual advises he or she cannot furnish proof of payment, direct the claims folder to the Reconsideration Branch by means of a SSA-559 route slip. Advise the Reconsideration Branch that since proof of payment cannot be verified, the case is being forwarded for their determination. Include an explanation on the route slip regarding attempts made to locate a payment.
If an enrollee does not allege payment of SMI premiums before the end of the grace period but nevertheless feels that SMI coverage should be reinstated, direct the request to the DO requesting development per HI 01001.300.
When a claimant protests the termination of SMI coverage and alleges an inability to pay the premiums, send a copy of the protest to the DO via Form SSA-5075 requesting the development of a premium payer per HI 01001.225.