Premium problems are those in which there is a question about one or more of the following:
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Incorrect premium deduction (dual Social Security, civil service, or railroad retirement
premium deductions are not incorrect premium deductions). This type of problem cannot
be resolved by reviewing the Health Insurance Query Response (HIQR). Use an overprint
SSA-5002-HB and refer the problem to the appropriate program service center (PSC);
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Incorrect premium billing or incorrect check amount applied to enrollee’s record;
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Hospital Insurance-Supplementary Medical Insurance terminated for nonpayment of premiums;
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Private third party group payer; or
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Civil service deductions of premiums from an annuity.
It is very important to correctly identify the nature of the enrollee’s problem since
this dictates the action to be taken.
Example: Mr. James comes into the field office (FO) and alleges nonreceipt of either a HI card
or any premium bills. The Master Beneficiary Record (MBR) and the HIQR show no information
on file or "NIF" even though the enrollee has alleged an apparent premium problem.
This is actually an "entitlement problem" and the procedure in HI 00930.001 applies. This situation cannot be a premium problem since no entitlement exists.
Premium problems are divided into three categories: individual payer, group payer,
and civil service. Individual payer problems include problems that do not involve
a private third party group or civil service.