A deemed IEP may be established for an individual born on the first day of a month
a person files an enrollment request in the first month after the IEP.
Since individuals born on the first day of a month are ordinarily unaware that they
actually attain a given age in the preceding month, the deemed IEP provision will
be applied without further development.
IMPORTANT: If there is evidence in file that demonstrates that the enrollee knew the “prior-month” attainment rule, do not establish a deemed IEP.
EXAMPLE:
IEP occurring
before
January 1, 2023 - John Allen DB 3/1/1920, enrolled on 6/22/1985. Although John's enrollment request
was filed in the month after expiration of John's actual IEP, a deemed IEP of 12/1984-6/1985
is established and SMI coverage is effective 9/1/1985. If John had enrolled in 3/1985,
John's SMI coverage would be effective 5/1/1985, see HI 00805.165B.2. A deemed IEP could not be established since John enrolled during the actual IEP.
IEP occurring on or after January 1/2023 - Allen Grady turned 65 5/1/2023 and enrolled on 8/28/2023. Since Allen filed his
enrollment request after the end of this IEP, Allen’s is given a deemed IEP of 4/2023-8/2023.
Allen’s SMI would be effective 9/2023, see HI 00805.165B.1.