A beneficiary can only choose the effective date for a Special Enrollment Period (SEP)
in limited circumstances when the beneficiary is or was covered by a group health
plan (GHP or LGHP) based on current employment, as outlined in HI 00805.276.
The enrollment request for supplementary medical insurance (SMI), or premium-hospital
insurance (HI), for individuals applying under a GHP/LGHP SEP should include the statement
“I want Part B coverage to begin (MM/YY)” on the CMS-40B form if:
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the aged beneficiary files the request while currently covered under a GHP based on
current employment;
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the disabled beneficiary files the request while currently covered under a large group
health plan (LGHP) based on current employment status; or
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the beneficiary files the request during the first month after such coverage ends.
LGHP refers exclusively to disabled beneficiaries who are under age 65. A GHP for
someone aged is of any size, so it may be an LGHP, or it may not. Refer to HI 00805.266.
Example of a beneficiary choosing the effective date in an SEP enrollment request:
Morgan has entitlement to Social Security benefits since age 62. Morgan refused SMI
when first eligible in August 2010 because they were still covered under a GHP based
on their current employment status. Morgan decides to retire at the end of September
2014, applies for SMI in July 2014, and signs a statement requesting an effective
date of October 2014.
Individual Coverage Health Reimbursement Arrangement, or ICHRA’s are not eligible for this SEP.