Effective Dates: 06/08/2023 - Present Previous | Next

TN 83 (06-23)

HI 00805.245 Development for SMI Enrollment of Civil Service Annuitants and Their Spouses

A. Policy - Interviewing

1. Annuitants

During the course of obtaining an application for Supplementary Medical Insurance (SMI) from an individual who is:

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    not entitled to monthly benefits under substantial services (SS),

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    not entitled to an annuity or pension under Railroad (RR), and

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    not eligible for coverage under a State buy-in agreement,

the district office (DO) should ask whether or not the applicant is a Civil Service annuitant or the spouse of an annuitant.

If a person enrolling is an annuitant, this information and the civil service annuity number should be shown in the file. The claim should not be sent to the Program Service Center (PSC) until the correct annuity number is obtained. Otherwise, rejection, incorrect premium collection or delay in collection for several months will occur.

2. Spouse of annuitant

Where an annuitant's spouse is enrolled in SMI and subject to SMI premium direct payments, the annuitant's spouse may also have SMI premiums withheld from the annuitant's monthly check if the annuitant consents in writing or verbally and the spouse is:

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    enrolled in SMI;

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    not entitled to a civil service annuity or any Retirement and Survivors Disability Insurance (RSDI) or RR benefits, and

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    not subject to State buy-in.

This arrangement is optional for the convenience of the annuitant and the spouse.

NOTE: Office of Personnel Management (OPM) will only deduct for a current spouse.

The annuitant must consent in writing or verbally to OPM's deduction of the spouse's SMI premiums from the annuitant's monthly check. The written authorization from the annuitant may be similar to the following:

I agree that the monthly premium to cover medical insurance for my spouse (name), be deducted from my civil service annuity check.

3. Civil Service Annuity (CSA) annuity number

The exact annuity number including the designation Civil Service Annuity (CSA) (retired annuitant) or Civil Service Final (CSF) (survivor annuitant) must be provided by the claimant.

Annuity numbers are assigned in numeric sequence as awarded.

NOTE: Both CSA and CSF numbers recently entered the seven-digit category although the majority of valid annuity numbers at the present time consists of six-digits. A few annuitants with five-digit numbers are still living and on the annuity rolls.

Annuity numbers of five or fewer digits should be questioned and validated. Two minor annuity designations, LSF and CZC, exist and may contain three and four-digit numbers, but these cases are rare.

Because of the critical timing of the SSA Automated Data Processing (ADP) system of SMI premium certification and the unique requirements of the OPM system, neither OPM premium deductions nor cessation of OPM premium deductions can begin until after the month for which it is effective. A delay of 4 months may be expected with full retroactive adjustment by the OPM.

4. RSI beneficiary, benefits suspended

Certification for SMI premium deductions from the civil service annuity applies to beneficiaries who are entitled to Medicare only. These are:

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    insured and age 65 or older (BIC-T)

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    ESRD (BIC-T)

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    deemed insured for Medicare only (BIC-T)

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    insured based on Medicare Qualified Government Employment (BIC-TA) and

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    uninsured age 65 or older (BIC- M).

The policy also applies to special age-72 claimants (BIC-J or K) who are entitled to SMI and are in total suspense because of Government pension offset, or whose monthly benefit payment is less than the SMI premium.  (See SM 00550.010 for information on BICs and type of payment).

RSDI beneficiaries are subject to SMI premium withholding from their monthly benefit. During periods of suspense, for work or other reasons, the beneficiary makes direct premium payments.

If a Civil Service annuitant, entitled to a social security benefit, but not receiving payment because of, e.g., government pension offset, wants the Part B premium deducted from the Civil Service annuity, they may wish to withdraw the monthly benefits portion of the application and be entitled to “HI only.” (This procedure is explained further in HI 00801.022C and HI 01001.190B.)

B. Policy - Independent Federal systems

Certification for SMI premium deductions cannot be made from an annuity that is payable by an independent Federal retirement system other than OPM.

C. List of independent Federal systems

The following is a list of independent Federal civilian retirement systems (some of which are quite limited in the scope of their coverage):

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    Federal Employees' Compensation - Federal employees or their survivors may be entitled to employees' compensation which, in some cases, may be received in lieu of a CSC annuity. Employee compensation benefits are administered by the Bureau of Employees' Compensation, Department of Labor.

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    Foreign Service Retirement and Disability System - This system for foreign service employees is administered by the Department of State.

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    Federal Reserve Board Retirement System.

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    Judicial Survivor Annuity System - This system, administered by the Administrative Office of the U.S. Courts, provides survivor's benefits for the widows of Federal judges.

    NOTE: The judges themselves are continued in a salary status when “retired.” Other Federal court employees and their survivors are covered under regular civil service retirement.

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    Lighthouse Service Retirement System - The U.S. Coast Guard administers this system for lighthouse keepers and ancillary personnel.

    NOTE: Upon the annuitant's death, jurisdiction over a survivor claim is transferred to OPM.

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    Tennessee Valley Authority Retirement System.

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    District of Columbia Policemen and Firemen's Retirement System.

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    District of Columbia Public Schoolteachers' Retirement System.

NOTE: Any District of Columbia employee not covered by either of the two special District of Columbia systems is covered by regular Federal civil service retirement.

Except for the benefits and annuities listed above, and for retirement from the Armed Forces, all other Federal retirement systems are administered by OPM. If a claimant says that they are receiving a benefit or annuity from one of the independent systems, this information should be included in the file to explain why the premium deductions will not be made from a CSC annuity.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805245
HI 00805.245 - Development for SMI Enrollment of Civil Service Annuitants and Their Spouses - 06/08/2023
Batch run: 06/08/2023
Rev:06/08/2023