HI 01001.255 Beneficiary Dropped From Group Payment Plan

When a Formal Group Payer gives notice that a beneficiary is (or was) no longer eligible for group payment as of a particular date for a reason other than death, the Centers for Medicare & Medicaid Services (CMS) asks the beneficiary to pay his or her premiums by direct remittance. Similarly, CMS in some cases will notify the group that premiums are no longer to be paid for specified individuals. Because of the prohibition against disclosure of information, explanation will not be given by CMS for the reason it is “deleting” the beneficiary from the group payment arrangement, when the premiums must be deducted from Social Security (SS) benefits which became payable because the beneficiary is no longer working or because age 72 was attained. When the beneficiary is dropped from a group payment arrangement, premiums will be deducted, where appropriate, from his or her benefits, or he or she will be sent individual bills.

When CMS is notified that a beneficiary has been dropped, the beneficiary will be billed directly for his or her premiums. The time and manner of billing, and the due date and grace period, will be determined in accordance with the rules for beneficiaries or nonbeneficiaries, whichever are applicable.