Disabled beneficiaries who did not enroll in SMI during the D-SEP may only enroll during a GEP.

When a GEP enrollment request is received for a beneficiary who did not enroll during the D-SEP, the FO will:

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  Take Form CMS-40B.

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  Prepare a Report of Contact stating that the beneficiary did not enroll during the D-SEP and indicating the months to be excluded from the premium surcharge calculation.

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  Annotate “Premium Surcharge Rollback” prominently at the top of the Report of Contact.

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  Attach a copy of the employer letter and carrier certification and forward the enrollment package to the PSC.

Send the beneficiary a Form CMS-40B.

Advise the individual that they will need a letter from their employer and a copy of the Medicare carrier certification in order to verify the months to be excluded from the premium surcharge calculation. Refer the beneficiary to the employer to secure the required evidence.

Tell the individual to take both letters and the Form CMS-40B to the local Social Security FO to enroll in SMI. Give the beneficiary the FO address.

Process the GEP enrollment via MACADE.

Carole Simms, employed at United Banking, Inc. since 7/85, has been on long term disability since 1993. Carole was entitled to Part A effective 3/95, but refused Part B. Carole was notified in 10/98 that effective 1/99, the LGHP would no longer pay primary to Medicare. Carole received the employer letter indicating the months the plan paid primary and the carrier certification. Carole did not enroll in SMI during the D-SEP which was 1/99 through 7/99.

In February 2000, Carole applies for SMI and inquires about the D-SEP. Carole is told that the D-SEP ended 7/31/99 and the application must be treated as a GEP enrollment. However, all months the plan paid primary are excludable from the premium surcharge calculation. Carole is assessed a premium surcharge of 10 percent since the months the employer was not primary payer of benefits (January 1999 through March 2000, a total of 15 months) are not excludable from the surcharge calculation.