TN 38 (11-20)

HI 00805.350 Special Enrollment Period for International Volunteers

A. Policy for a special enrollment period for international volunteers

Section 1837 (k) of the Social Security Act provides a 6- month special enrollment period (SEP) for Medicare Part B and Premium Part A for an individual who:

  • either (a) elected not to enroll (or to be deemed enrolled, see HI 00805.040) when first eligible for an initial enrollment period (IEP), or (b) terminates enrollment while serving as a volunteer; and

  • is serving as a volunteer outside of the United States through a program that covers at least a 12-month period; and (b) is sponsored by a tax-exempt organization describe in section 501 (c)(3) of Internal Revenue Code of 1986 and is exempt from taxation under section 501 (a) of the Internal Revenue Code of 1986; and(For the definition of sponsoring

  • the individual demonstrates that he or she has (or had) health insurance that provided coverage to the individual while he or she was outside of the U.S. for the duration of the volunteer service. Evidence of coverage under a national health plan is acceptable health coverage for this SEP. See HI 00805.295

NOTE: The beneficiary is serving as a volunteer through a program that covers at least a 12- month period; however, the beneficiary does not need to serve as a volunteer for 12 months in order to qualify for his SEP.

EXCEPTION: Individuals who are entitled to Premium- Part A under the Premium-Part A for the Working Disabled provision are not eligible to enroll during the SEP for International Volunteers.

B. Definition of sponsoring organization

A sponsoring organization may be a social, religious, educational, scientific, or charitable organization The program sponsoring organization must be described in section 501(a) (c)(3) of the Internal Revenue Code (IRC) of 1986 and exempt from taxation under section 501(c)(3) of the IRC of 1986.

The following are key limitations on these organizations:

  • no part of the net earnings of the sponsoring organization may inure[1] to the benefit of any private share holder or individual

  • no substantial[2] part of the activities of the sponsoring organization may be carrying on propaganda[3] , otherwise attempting, to influence legislation (except as otherwise provided or permitted in section 501(h) of the IRC); and

  • the sponsoring organization must not participate in, or intervene in (including the publishing or distributing of statements), any political campaign on behalf of ( or in opposition to) any candidate for public office. See HI 00805.355

The sponsoring organization can be a corporation(s) or any community chest, fund, or organized foundation that operates exclusively for:

  • religious purposes,

  • charitable purposes,

  • scientific purposes,

  • testing for public safety purposes,

  • literary or educational purposes,

  • fostering national or international amateur sports competition (but only if no part of its activities involve the provision of athletic facilities or equipment), or

  • the prevention of cruelty to children or animals.

C. General eligibility requirements for the SEP for international volunteers

An individual is eligible to enroll during the SEP if he or she meets the requirements discussed in HI 00805.350A, in this section, and one of the following requirements.

1. No previous SMI or premium-HI enrollment

If the individual did not enroll in the initial enrollment period (IEP), he or she had to meet the requirements in HI 00805.350A in this section, in the first month of eligibility for SMI or Premium-HI and all months thereafter.

The first month of eligibility for SMI and Premium-HI is the fourth month of the IEP, as explained in HI 00805.015.

Example of individual with no previous Medicare Part B or Premium-PART A enrollment: Ms. Janacek refused Medicare Part B in her initial enrollment period. At that time, she was serving as an international volunteer oversees for the catholic medical mission board and was provided health insurance coverage. She is now enrolling using the SEP for international volunteers.

2. Previous SMI or premium-HI entitlement

If the individual enrolled during the IEP and later terminated coverage, he or she had to meet the requirements in HI 00805.350A in this section the month of SMI or Premium-HI termination and all months thereafter.

If the individual was previously enrolled in Medicare Part B or Premium-Part A and later terminates coverage, he or she had to meet the requirements in HI 00805.350A of this section at the time of the Medicare Part B or Premium-Part A termination and all months thereafter.

Example of individual with previous IEP Medicare Part B or Premium- Part A enrollment:

Mr. Nelson at age 65 enrolled in Medicare B during his Initial enrollment period (IEP). At age 66, Mr. Nelson terminates his Medicare Part B coverage, while serving as a teacher volunteer outside the United States. Mr. Nelson was provided health insurance coverage outside of the country for 12 months for his volunteer service. After 12 months, Mr. Nelson returns to the United States to enroll in Medicare Part B using the SEP for international volunteers.

Example of individual with previous GEP (or SEP) Medicare Part B or Premium-Part A entitlement: Mr. Nelson at age 65 enrolled in Medicare in January during the General Enrollment Period (GEP). In August, Mr. Nelson terminates his Medicare Part B coverage, while serving as a medical volunteer outside of the United States through a medical volunteer program that lasts for 13 months. After 13 months, Mr. Nelson returns to the United States to enroll in Medicare Part B using the SEP for international volunteers.

Only individuals who qualify for this SEP can use months of international volunteer service for premium surcharge rollback, and only during this SEP. 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 month of filing. See HI 01001.010.

D. Policy for the effective date of the SEP for international volunteers

The SEP for international volunteers was effective January 1, 2007. Premium-surcharge rollback only applies to months of international volunteer service as defined in HI 00805.350A (in this section) beginning January 1, 2007.

Effective July 1, 2006, or later, an individual who meets the requirements in HI 00805.350A and HI 00805.350C (in this section) is eligible to enroll in Medicare Part B and Premium-Part A during the SEP.

E. Policy for when enrollment for volunteers can occur

The SEP is the 6-month period beginning on the first day of the month that includes the date that the individual no longer satisfies the eligibility requirements for the SEP. Therefore, SEP begins on the first day of the month that includes the date the individual is:

  • no longer serving as a volunteer outside of the United States;

  • no longer has health insurance coverage while serving as a volunteer,

  • no longer serving in a program that covers at least a 12-month period and is sponsored by a non-profit organization (loss of tax-exempt status). Either a change in the duration of the volunteer program or in the tax-exempt status of the organization sponsoring of the program will trigger the SEP.

Examples:

  • An individual stops being a volunteer on October 25, 2019. The SEP begins on October 1, 2019, and lasts a total of 6 months. Thus, the individual’s SEP would be from October 2019 – March 2020.

  • An individual is volunteering abroad and the non-profit stops providing health coverage on December 15, 2019. The SEP would begin December 1, 2019, and end May 31, 2020.

  • An individual is volunteering abroad and the non-profit organization sponsoring the volunteer program loses its tax exempt status (it is no longer a non-profit organization) on April 10, 2020. The SEP would begin April 1, 2020 and end September 30, 2020.

F. Policy for the effective date of SMI and/or Premium-HI coverage

Coverage is effective the first day of the month following the month of Medicare

Part B or Premium-Part A enrollment.

 

G. PC Processing of Medicare Part B Special Enrollment for International Volunteers

The Field Office (FO) cannot process this type of enrollment action through POS. The FO must scan the pertinent documents to Paperless for MACADE input by the servicing Processing Center (PC). See SM 00850.550 - Special Enrollment for International Volunteers for detailed MACADE coding instructions.

H. References

  • HI 00801.170 Premium-HI for the Working Disabled

  • HI 00805.015 Initial Enrollment Period

  • HI 00805.040 Automatic (Deemed) Enrollment Aged and Disabled Individual

  • HI 00805.295 Evidence of GHP or LGHP coverage based on Current Employment Status

  • HI 00805.355 Evidentiary Requirements for the SEP or Premium Surcharge Rollback for International Volunteers

  • HI 01001.010 Premium Increase for Late Enrollment

  • SM 00850.550 Special Enrollment for International Volunteers for detailed MACADE coding instructions

 


Footnotes:

[1]

Inure means to be applied; to serve to the use

[2]

Substantial means of considerable importance, size, number or amount

[3]

Propaganda means information, especially of a biased or misleading nature, used to promote or publicize a particular political cause or point of view


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600805350
HI 00805.350 - Special Enrollment Period for International Volunteers - 04/18/2012
Batch run: 11/23/2020
Rev:04/18/2012