TN 19 (03-93)

HI 00805.230 Delayed Deletion from State Buy-In Rolls Prejudices Termination Rights

A. Background

People who wish to terminate individual SMI coverage after buy-in ends face financial disadvantages if delayed deletion occurs.

B. Policy

1. General

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.

2. Equitable relief

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:

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

  • 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

  • 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.

3. Equitable relief not applicable

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.).

C. Procedure - SMI cancellation

1. Use of Form HCFA-L1636

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

NOTE: This form is normally the source of the date of the buy- in deletion notice for purposes of determining the 30-day period in which relief under this section is applicable.

2. HCFA-L1636 is not available

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.

NOTE: If a PSC contact is needed because the MBR does not have the transaction date, the date of the letter would be 7 days after the run date shown on the form SSA-1596-C1 (Record of Changes in Premium Deduction or Billing Status).

D. Procedure - Withdrawal of SMI termination

If a beneficiary cancels SMI under this section and later decides he/she acted hastily, reinstate SMI if the request to do so is received on or before the 60th day after the date of Form
HCFA- L1636.

To Link to this section - Use this URL:
HI 00805.230 - Delayed Deletion from State Buy-In Rolls Prejudices Termination Rights - 11/20/2001
Batch run: 06/08/2015