Under current procedures, an individual"s SMI coverage under buy-in can be terminated retroactively for as many as 2 months before the State"s notice to CMS that he/she is no longer entitled.

After receipt of the notice from the State, a notice will be sent (usually a HCFA-L1636) to the individual. It advises that he/she is responsible for paying the SMI premiums beginning with the month following the last month of buy-in coverage.

Because of administrative delays, a beneficiary can already be in the third month after buy-in termination and owe 3 months SMI premiums before he/she is even notified that the buy-in coverage has been terminated.

Equitable relief can be granted to allow an individual"s SMI coverage to end effective with the termination of buy-in coverage, thus allowing him/her to avoid entirely any premium liability. To do this, all of the following conditions must be met:

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  the individual submits a written request to have the individual SMI coverage end effective with the end of buy-in coverage;

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  such request is filed within 30 days of the date of the HCFA-L1636 or other notice informing the beneficiary of the buy-in termination; and

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  the individual certifies that he/she has incurred no medical services covered under SMI after the last month of buy-in coverage.

REMINDER: An individual granted retroactive SMI termination should be cautioned that if he/she receives reimbursement for services received after buy-in ended, the amount of that reimbursement represents an overpayment and can be collected later upon reenrollment.

If he/she is a monthly social security or Railroad Retirement beneficiary, it is collected from monthly benefits.

If an individual says that he/she had medical expenses covered under SMI after buy-in ended, equitable relief does not apply.

SMI entitlement must be terminated at the end of the month in which the termination request is filed (if the request is filed within 6 months of buy-in termination, see HI 00820.035 B.5.).

Ask the beneficiary to submit Form HCFA-L1636, if he/she wishes to cancel SMI.

If Form HCFA-L1636 has been destroyed or is otherwise unavailable, assume that the date of the letter is 7 days after the annotation to the TTDS (Third Party Termination Date - State) to the MBR.