HI 01001.150 Processing RRB Form RR-80

Forms RR-80 will be received from the Claims Authorizer concerning those beneficiaries for whom RRB has relinquished HI/SMI jurisdiction. These beneficiaries are usually females who have become either widowed or divorced from an RRB annuitant or widows who have remarried. The required action will consist of either a change of data currently present on the MBR or the processing of a new debit with the appropriate coding.

For those who are currently entitled as primary beneficiaries (BIC A) on SSA rolls, the processing of the Form RR-80 will usually require only the transfer of HI/SMI jurisdiction from RRB to SSA. These cases will be routed to the Health Insurance and Inquiries Examiner for the preparation of a credit/ debit on which the proper HI/SMI entitlement data will be coded (with particular regard to the use of health insurance change (HIC) code of “F”). The applicable coding entries may be determined from the Form RR-80. Item 10 of the form reflects the reason and date that RRB jurisdiction ended. Item 9 reflects the date of entitlement to HI. Item 11 reflects the beneficiary's first date of entitlement to SMI. Item 12 reflects the second period, if applicable. The premium rate is indicated in item 13 and the month through which premiums were collected is shown in item 14.