DI 45001.205 FO Responsibilities for ESRD Claims

The district offices should not develop insured status based on federal employment if HI entitlement based on social security quarters of coverage (SSQC) can be established. FQC's earned after December 1982 may be used alone or in combination with SSQC's to establish R-HI insured status for a federal employee, his or her spouse or dependent child. Additionally, deemed FQC's may be used to establish a federal employee's R-HI insured status provided he or she was in pay status during January 1983 and he or she does not have sufficient FQC's (earned after 1982) and SSQC's to be fully or currently insured. These deemed FQC's cannot be used to establish R-HI insured status for a spouse or dependent child unless the federal employee is entitled to HI.

If the district office takes an ESRD Medicare claim and the claimant requests HI entitlement based on federal employment, the file should also include a supplemental SSA-795 completed by the claimant.

Whenever the claimant's insured status is based on FQC's (deemed or regular), the claim should be forwarded to ODO with a covering claims transmittal from annotated in red “Medicare Based on Federal Employment.” Also, in this insured status situation, entitlement will be established under the federal employee's SSN.