If an individual elects resumption of title II benefits during appeal, D-HI is affected as follows:

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  If D-HI was awarded prior to the termination date required by the disability cessation, D-HI is resumed effective with the first month for which title II benefit payments are resumed, see example C.1.

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  If an individual had not completed the 24 month D-HI qualifying period prior to the scheduled termination, months of benefit continuation during the appeal period count toward the Medicare qualifying period. D-HI is awarded with the 25th month for which the individual receives title II disability benefits, see example C.2.

An individual may elect only Medicare reinstatement during the appeal period provided HI had been awarded prior to the scheduled title II benefit termination date. Where reinstatement of only Medicare is requested, HI is resumed effective with the month title II benefits would have been reinstated had title II benefit continuation been elected, see example C.3.

Where HI is resumed during appeal, SMI is affected as follows:

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  If the individual was entitled to SMI prior to termination, SMI is reinstated effective with the same month of the HI reinstatement, unless the individual requests that SMI not be reinstated. In that case, the request that SMI not be reinstated is treated as a request for termination, with coverage ending the end of the month after the month the request was filed.

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  If the individual was not entitled to SMI prior to termination because previously refused SMI or allowed coverage to lapse, may enroll for SMI only during a GEP or SEP which occurs while the appeal is pending.

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  If HI was not in effect at termination, but is awarded during the benefit continuation period, SMI is also awarded.

Premium surcharges for SMI will apply only in the following situations:

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  A surcharge was in effect at the time of title II termination. The same percentage surcharge will apply during the benefit continuation period.

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  SMI was refused during the IEP or at the time of benefit election but later elected during a GEP or SEP occurring during the benefit continuation period. The months to be counted toward the surcharge will be those elapsing after the end of the IEP through the end of the enrollment period in which the individual enrolls.

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  If SMI was terminated earlier than HI (either voluntarily or for non-payment of premiums), months after the last month of SMI coverage will be counted for surcharge purposes where reenrollment occurs during a GEP or SEP in the benefit continuation period.

One received DIB for more than 24 months and was entitled to Medicare prior to a determination the impairment was no longer disabling. If one files an appeal and makes a request for title II benefit continuation within 10 days of the cessation notice, HI is resumed effective with the same month title II disability benefits are resumed.

Mary received DIB from 7/91 through 10/92, a total of 16 months, when her DIB was terminated because of medical improvement. Although she requested reconsideration of the disability cessation in 11/92, she did not elect title II benefit continuation. The cessation was upheld at the reconsideration level and Mary requested an ALJ hearing and benefit continuation. Her DIB was reinstated beginning 2/93, the month of the reconsideration determination. If her appeal is still pending, she will be awarded D-HI beginning 10/1/ 93. That is, the 8 benefit continuation months 2/93 through 9/93 are added to the 16 months of DIB entitlement from 7/91 through 10/92 to complete the 24 month D-HI qualifying period. Note that the months 11/92 through 1/ 93, for which no title II payments were made, are not counted as months in the D-HI qualifying period.

Joan, who was entitled to D-HI, received a disability cessation notice in 3/ 92. DIB and HI terminated effective 4/30/92. She immediately filed for reconsideration and elected reinstatement of her Medicare only. Since her title II benefits would have been reinstated 5/92 (had she elected title II continuation), HI is reinstated beginning 5/1/92. If Joan had not completed the D-HI qualifying period prior to DIB termination, she would not have had the option to elect HI only reinstatement.