In some cases, an individual who is otherwise eligible for enrollment on the basis
of the deemed IEP provision may decline SMI enrollment (e.g., because the individual
prefers other insurance, etc.). If that individual seeks to enroll for coverage at
a later date, the deemed IEP protection no longer applies.
Similarly, if an individual was enrolled in SMI on the basis of a deemed IEP but that
person allows coverage to lapse (either through non-payment of premiums or based on
a request for termination), the premium protection afforded by the deemed IEP provision
is not applicable should the person reenroll for coverage at a later date.
In determining the amount of the individual's SMI premium surcharge for late enrollment,
months of non-coverage will be counted beginning with the month following the end
of the person's actual IEP, keeping in mind that some months of non-coverage may not be countable because of
the working aged provision (see HI 00805.295).
EXCEPTION: If an individual would be eligible for an SEP and/or premium surcharge rollback because
of coverage under an employer group health plan (EGHP), the deemed IEP protection
continues for that person. All determinations for SEP and/or premium rollback purposes
will be based on the deemed date of birth and deemed IEP.