The first month of R-HI entitlement (HI based on ESRD) is the first month of R- SMI
eligibility. Therefore, the IEP begins with the third month prior to the month of R-HI entitlement.
R-HI claimants are deemed enrolled in R-SMI in the first 3 months of their IEP (unless
such an award results in a premium arrearage of 6 months or more (see 2. below)).
R-SMI entitlement generally begins with the first month of R-HI entitlement. As in
all automatic enrollment cases, R-HI claimants have the right to refuse R-SMI.
CAUTION: Since the cost of dialysis is so high, claimants who refuse R-SMI will be questioned
closely to see if they are making a sound decision. See HI 00801.191 C. and HI 00801.251.
IMPORTANT: Puerto Rican residents and persons outside the U.S. who are not subject to automatic
enrollment, as explained in HI 00805.050, nevertheless have R-SMI beginning at the same time as R-HI, under the terms of the
ESRD provision, unless they refuse SMI timely.