E. Part B effective dates
Individuals who meet the criteria for equitable relief can enroll in Part B from September 1, 2016 through September 30, 2018. The effective date for Part B coverage can begin either:
• The month the beneficiary enrolls, or
• At the beneficiary’s option, any of the two months prior to the month of enrollment.
F. Processing equitable relief
1. Consider whether all the requirements in Section D of this instruction are met.
2. Collect the beneficiary’s statement, proof of Marketplace coverage, and any available evidence.
3. For beneficiaries requesting Part B enrollment, complete the following steps:
4. Prepare a Form SSA-5002 (Report of Contact) giving your analysis of the information, any evidence provided, request for surcharge removal, and your decision as to whether relief should or should not be provided. Include the reasons for approval or disapproval based on your review.
· If the beneficiary expresses dire need of medical attention, refer the action to the program service center (PSC) of record following existing instructions in GN 01070.228.
· Complete Form CMS-40B (Application for Enrollment in Medicare Part B (Medical Insurance)).
· For beneficiaries who were in their SEP October 1, 2013 or later, obtain evidence of Group Health Plan (GHP) coverage or Large Group Health Plan (LGHP) coverage based on current employment via Form CMS-L564 (Request for Employment Information).
· If the beneficiary wants a retroactive effective date, explain that payment of all premiums for all months of coverage is required. Explain that the total amount of premiums for all months, including the next coverage month, may be deducted all at one from his or her benefit amount. Be sure the beneficiary understands the implications for a retroactive effective date before processing.
· Include in the remarks sections of the CMS-40B the beneficiary’s Part B effective date choice according to section E of this EM.
· Print the CMS-40B barcode from NDRED.
5. Fax the completed CMS-40B, SSA-5002 and supporting documentation (e.g., the CMS-L564 and the beneficiary’s notice from CMS) into CFRMS.
6. Forward the case to the appropriate PSC for review and processing.
1. Review the beneficiary’s statement, proof of Marketplace coverage, proof of GHP/LGHP coverage based on current employment, and any available evidence in support of SSA-5002 determination.
2. Process approved equitable relief case following normal Equitable Relief procedures.
3. If the beneficiary is eligible for surcharge reduction, remove the existing surcharge. Apply excess premiums to any past-due premium amounts owed. If no past-due amounts are owed, refund the excess premiums to the beneficiary.