TN 12 (02-26)
The option to elect statutory benefit continuation (SBC) only applies to the following individuals:
Primary disability beneficiaries (i.e., the number holder (NH) in a disability insurance benefits (DIB) case).
Auxiliaries receiving benefits on the record of a primary disability beneficiary. (An auxiliary has the option to elect SBC, but the primary disability beneficiary must elect SBC for DIB and for the auxiliary’s benefits before the auxiliary may receive SBC.)
Disabled widow(er)s.
Disabled adult children.
Mothers/fathers receiving benefits based on having a disabled child in care.
Supplemental Security Income (SSI) recipients whose SSI eligibility is based on disability or blindness.
Individuals receiving special SSI payments or Medicaid eligibility under section 1619(a) and (b) of the Social Security Act (Title XVI provisions) (see sections in SI 02302.000).
NOTE:
Medicaid eligibility will continue for SSI recipients electing SBC in states where the Social Security Administration (SSA) determines Medicaid eligibility.
In a concurrent case, a beneficiary may elect to receive SBC on Title II or both titles.
For information on processing SBC elections on the SSA-792 (Statutory Benefit Continuation Election Statement), see DI 12027.010.
An individual may request SBC of Medicare coverage with or without also requesting continuation of disability benefits.
The beneficiary may elect SBC of both Parts A and B or only Part A or Part B.
Generally, an individual who was entitled to Part A only at the time of disability entitlement may enroll for Part B coverage only during the General Enrollment Period (GEP) of January through March, with entitlement effective the first month after the month of the GEP enrollment. For more information on the GEP, see HI 00805.025.
When an individual elects SBC of Medicare-only, only the Medicare coverage that was in effect as of the date of disability termination will continue. The beneficiary will be billed directly for any Part B premium. If the premiums are not paid, Part B entitlement will terminate.
SBC does not apply to Medicare Qualified Government Employees (MQGE) only cases.
The primary beneficiary/NH electing SBC may:
Elect or decline to have benefits continue for any auxiliaries, and
specify which auxiliary may receive SBC and what benefit may continue.
An auxiliary may receive SBC only if the primary beneficiary also elects SBC for that auxiliary.
Each auxiliary receiving benefits on a DIB record has the option to elect or decline SBC.
Ask each auxiliary beneficiary eligible for SBC (or representative payee on their behalf, where appropriate, as described in DI 12027.010) to sign a separate SSA-792.