Effective Dates: 5/01/2025 - Present

Identification Number:
HI 01001 TN 62
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Supplementary Medical Insurance
Type:POMS Full Transmittals
Program:Medicare
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part HI – Health Insurance

Chapter 010 – Premium Collections

Subchapter 01 – Supplementary Medical Insurance

Transmittal No. 62, 05/01/2025

Audience

PSC: BA, CA, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CAQCR, CCRE, CR, EIE, ERE, PETL, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DES, 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

These updated are due to the enactment of the Social Security Fairness Act.

Summary of Changes

HI 01001.165 Civil Service Annuitants and Spouses

CMS DEEP and OHI worked with SSA OISP and OPSOS to update these POMS to remove reference to WEP and GPO.

HI 01001.165 Civil Service Annuitants and Spouses

This section describes how SSA notifies the Office of Personnel Management (OPM, previously the Civil Service Commission) to deduct premiums from annuities, and how to handle inquiries. Premium collection by the OPM for an annuitant's spouse is explained in HI 01001.020 C. SMI enrollment for civil service annuitants, their spouses, and preparation of awards for them is discussed in HI 00805.245.

The law provides that all uninsured (T or M) claimants who are receiving a civil service annuity from OPM, and have enrolled for SMI will have their premiums deducted from the civil service annuity. The annuitant may also authorize the deduction of a spouse's premiums from the annuity check.

If the civil service annuitant or the annuitant’s spouse has insured status and is entitled to Social Security retirement or auxiliary benefit, SMI premiums will be deducted from their monthly payments.

A. Notice to OPM

Each month, SSA certifies new uninsured annuitant and spouse data to the OPM. This information flows from the DO through the central processing operations to DP (via the EDP systems), and then to OPM. In general, a minimum of four months may elapse from the time of filing the application for SMI to the initial deduction of the premium from the annuity check. This includes processing time in the DO, PSC, CMS BSS and OPM.

B. Referral of Inquiries About OPM Deductions

SSA's arrangement with the OPM provides for central coordination and exchange of data. DO's and PSC's should not communicate directly with OPM. If the MBR shows that OPM has already been requested to deduct premiums from the annuity, and this is inconsistent with the statements in the inquiry, the DO sends an overprinted form SSA-5002 along with a current MBR printout and any related materials to CMS, BSS, Premium Processing Branch, P.O. Box 11977, Baltimore, Md. 21207. Remember to furnish the annuitant's name and correct Civil Service annuity number. (See HI 01001.375 B. and D. for a detailed explanation of the use of the overprinted RC and OPM inquiries.)


HI 01001 TN 62 - Supplementary Medical Insurance - 5/01/2025