The surcharge is determined by counting the number of months when an individual could
have been, but was not, enrolled in SMI after the end of the IEP through the end of
the enrollment period in which enrollment occurs. When calculating the number of months
during which an individual could have been, but was not, enrolled in SMI, months of
GHP or LGHP coverage are excluded, as described below.
Individual Coverage Health Reimbursement Arrangement, or ICHRA’s are not eligible for this SEP.
1. Exclusion of GHP months for the aged
Effective for premiums due for 6/86 and later months, the calculation of the surcharge
for late enrollment will exclude:
-
•
all months beginning with 1/83 (or the end of the IEP, if later) during which the
individual can demonstrate they were enrolled in a GHP based on the individual's own
or spouse's current employment status, even if the employer was not primary payer
(i.e., did not have 20 or more employees), and
-
•
all months of SMI entitlement.
2. Exclusion of GHP months for the disabled
Effective for premiums due for 1/87 and later months, the calculation of the surcharge
for late enrollment will exclude:
-
•
all months beginning with 1/87 (or the end of the IEP, if later) during which the
individual can demonstrate they were enrolled in a GHP based on the individual's own
or spouse's current employment status, and
-
•
all months of SMI entitlement.
The earliest month for which the premium rollback can be effective is 7/90.
3. Exclusion of LGHP months for the disabled
Effective for premiums due for 1/87 and later months, the calculation of the surcharge
for late enrollment will exclude:
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•
all months beginning 1/87 (or the end of the IEP, if later) through 7/93 during which
the individual can demonstrate they were enrolled as an active individual in an LGHP
(see HI 00805.752A.1 for an explanation of “active individual”), and
-
•
all months beginning 8/93 during which the individual can demonstrate that they were
enrolled in an LGHP based on their own or a family member's current employment status,
and
-
•
all months of SMI entitlement.