SMIB Termination Reversal Paragraphs—Computer Generated if Effective Month of Buy-in
Precedes Termination Month Shown as “MT” Factor in Item 7 of SSA-101
|
6K |
None |
Disallowance of Claim for Hospital Insurance—Not Full Retirement Age |
265 |
1 |
Disallowance of Claim for Hospital and Medical Insurance Coverage—Not 65—Applicant
Filed Under Deemed Insured Provision
|
266 |
1 |
Medical Insurance Beneficiary (“M” BIC) Potential Entitlement as Spouse of Premium Payer |
267 |
1 |
Covered or Potentially Covered Under the Federal Employees Health Benefits Act of
1959—Deemed Insured
|
272 |
None |
Applied Before Beginning of Initial Enrollment Period |
274 |
None |
Not a Resident of One of the 50 States or the District of Columbia |
278 |
1 |
Special QC's Requirement for Entitlement to HI Under Deemed Insured Provisions—Full
Retirement Age In or After 1968
|
284 |
2 |
Chronic Renal Disease Disallowance—Opening Paragraphs |
290 |
1 |
Disability Established—Health Insurance Coverage Date Begins More Than 2 Months After
the Current Operating Month, HI/SMI Begins in Same Month
|
295 |
1 |
Medicare Termination—Revised Date of Entitlement |
297 |
1 |
to Disability Benefits |
297 |
1 |
Lead-in Paragraph—Medical Premiums Due |
368 |
2 |
Suspension of Benefits or Payment Deferred Beyond Current Year—Combined Payments—A
and B Beneficiaries Enrolled Under SMI (A Worked)
|
703R |
None |
Deferred Payment Action—To Recover Overpayment Liable for Premiums |
704 |
None |
Deferred Payment Action—To Recover Overpayment Redeferred for Premiums Due |
705 |
None |
One-Check-Only Followed by a Suspension-Combined Check Situation (A Worked)—Both A
and B Enrolled in SMI
|
707 |
1 |
One-Check—Only Followed by a Deferred Payment Action in Current Year |
708 |
1 |
To Secondary Beneficiary-Monthly Benefit Payable Less Than $1 |
709 |
5 |
To Secondary Beneficiary—Monthly Benefit Payable is Same as Premium |
710 |
2 |
To Secondary Beneficiary—Monthly Benefit Payable is Less Than Premium |
711 |
6 |
Representative Payee for HI and/or SMI Enrollee |
716 |
3 |
Termination of Monthly Benefits and HI With SMI Entitlement Transferred to New Account |
718 |
None |
Explanation of Medicare Premiums and Deductions Under Public Law (P.L.) 97-248, Sec.
278
|
719 |
None |
Discontinuance of State Buy—In Due to Non-Payment of SSI |
728 |
None |
Continuance of State Buy-In When SSI Payments Stopped |
729 |
None |
DIB Terminates—HI/SMI Coverage Terminates—No Refunds on Remittance Due |
741 |
1 |
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists—No DIB Overpayment
or Underpayment
|
742 |
4 |
DIB Terminates From Suspense—DIB Underpayment HI/SMI Premiums for Month Following
Month of Notice to be Deducted From DIB Underpayment—Beneficiary Not Billed for SMI
Premiums (to be used in conjunction with paragraph No. 741)
|
743 |
3 |
DIB Terminates From Suspense—DIB Underpayment for Months—HI/SMI Premiums for Month
Following Month of Notice to be Deducted From DIB Underpayment—Beneficiary Not Billed
for SMI Premiums
|
743(A) |
4 |
DIB Terminates From Suspense—No DIB Overpayments or Underpayments Beneficiary Billed
for SMI Premiums—Premium Arrearage Exists (to be used in conjunction with paragraph
No. 741)
|
744 |
4 |
DIB Terminates From Suspense—DIB Underpayment—Beneficiary Billed for SMI Premium—Premium
Arrearage Exists Which Will be Deducted From the Next Check (to be used in conjunction
with paragraph No. 741)
|
745 |
4 |
DIB Terminates From Suspense—DIB Underpayment for Multiple Months—Beneficiary Billed
for SMI Premiums—Premium Arrearage Exists Which Will be Deducted From the Next Check
|
745(A) |
5 |
DIB Terminates—HI Coverage Terminates—No SMI Coverage |
746 |
1 |
SMI Refund Paragraph (to be used in conjunction with paragraph No. 741 when excess
premiums will be refunded by SOBER)
|
747 |
None |
Medicare Ineligibility Paragraph (to be used when beneficiary's DOST and DOCA are
prior to the date of entitlement to HI/SMI. It is also to be used when a Future Cessation
Date (FCD) equal to or earlier than the date of entitlement to HI/SMI is being established.)
|
748 |
None |
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists Along With DIB
Overpayment
|
749 |
3 |
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists for One Month Along
With DIB Overpayment
|
749(A) |
3 |
DIB Terminates—HI/SMI Coverage Terminates—Premium Arrearage Exists for Prior Months
Along With DIB Overpayments
|
749(B) |
4 |
DIB Terminated From Suspense—DIB Overpayment Exists—Beneficiary Billed for SMI Premiums—Premium
Arrearage Exists (to be used in conjunction with paragraph No. 741)
|
750 |
3 |
DIB Terminated-Excess SMI Premiums Used to Reduce Overpayment |
751 |
4 |
DIB Terminated From Suspense—DIB Underpayment for One Month—Excess Premiums to be
Refunded by SOBER
|
752 |
6 |
DIB Terminated From Suspense—DIB Underpayment for Multiple Months—Excess Premiums
to be Refunded by SOBER
|
752(A) |
7 |
HI and SMI Coverage for RD Beneficiaries (Dialysis) |
790 |
None |
Closed Period—Entitlement/Termination (Dialysis) |
791 |
3 |
HI/SMI Termination Due to RD Cessation (Dialysis) |
792 |
2 |
Equitable Relief—RD Termination Cases—DOTH is Earlier Than DOTS—Beneficiary Not Notified
Timely (Dialysis)
|
793 |
4 |
HI and SMI Coverage for RD Beneficiaries (Transplant) |
794 |
2 |
HI/SMI Termination Due to RD Cessation (Transplant) |
795 |
2 |
Equitable Relief-RD Termination Cases—DOTH is Earlier Than DOTS—Beneficiary Not Notified
Timely (Transplant)
|
796 |
4 |
NH—Capacity for SGA |
850 |
1 |
NH—Impairment Not Severe—Medical Consideration Alone |
851 |
None |
NH—Impairment Not Severe—Medical Consideration Alone (Date ER Last Met) |
852 |
1 |
NH or Disabled Child—Impairment Not Expected to Last 12 Months |
853 |
None |
NH or Disabled Child—Impairment Did Not Last 12 Months |
854 |
None |
Disabled Child—Impairment Not Severe—Medical Consideration Alone or Condition Disabling
But Did Not Exist Before Age 22 (Over Age 22)
|
855 |
None |
Disabled Child—Impairment Not Severe—Medical Consideration Alone or Condition Disabling
But Did Not Exist Before Age 22 (Under Age 22)
|
856 |
None |
Disabled Child—Capacity for SGA—Vocational Consideration (Over Age 22) |
857 |
None |
Disabled Child—Capacity for SGA—Vocational Consideration (Under Age 22) |
858 |
None |
NH—Not Disabled Before Insured Status Expired |
859 |
2 |
NH—Not Insured at Alleged Onset Or Later |
860 |
None |
Disabled Widow(er)'s Prescribed Period Expired Before Alleged Onset |
861 |
2 |
NH—Explanation of Disability Requirement |
862 |
None |
Disabled Widow(ers)—Explanation of the Disability Requirement and the Prescribed Period |
863 |
None |
Expiration of Widow(er)'s Prescribed Period |
864 |
2 |
Childhood Disability—Law Paragraph—Claimant Age 22 or Over |
865 |
None |
Childhood Disability—Law Paragraph—Claimant Not Yet Age 22 |
866 |
None |
Widow(ers), Mother, Father or Surviving Divorced Spouse Entitled to Survivors Benefits—Claim
Filed for Medicare Coverage—Explanation of Disability Requirement for Medicare Coverage
|
867 |
None |
Widow(ers) Not Disabled—Lack of Severity |
868 |
None |
Widow(ers)—Not Disabled at Any Time Prescribed Period Requirement Met For Deemed Entitlement
to Medicare Coverage
|
869 |
1 |
NH—Disabled Widow(ers) or Child—Applicant Does Not Want to Continue Development of
Claim
|
870 |
None |
NH—Disabled Widow(ers) or Child—Failure to Follow Prescribed Treatment |
872 |
None |
Widow(ers) Not Disabled—Impairment is Severe at Time of Adjudication But Not Expected
to Last 12 Months
|
874 |
None |
Widow(ers) Not Disabled—Impairment No Longer Severe At Time of Adjudication and Did
Not Last 12 Months
|
875 |
None |
NH—Disabled Widow(ers) or Child—Insufficient Evidence Furnished |
876 |
None |
NH—Disabled Widow(ers) or Child Fails or Refuses to Submit to Medical Examination |
877 |
None |
NH or Widow(er) Has Demonstrated Ability to Engage in SGA Despite Condition |
881 |
None |
NH Demonstrated Ability to Engage in SGA Despite Impairment Within 29 Months Before
Attaining Full Retirement Age
|
883 |
None |
NH—Claim Filed After Death—Not Disabled at Any Time Earnings Requirement Met |
884 |
4 |
NH—Claim Filed After Death—Not Disabled—Lack of Severity |
885 |
3 |
NH—Claim Filed After Death—Not Disabled—Impairment is Severe At Time of Death But
Would Not Have Been Expected to Last 12 Months
|
886 |
2 |
NH—Claim Filed After Death—Not Disabled—Impairment No Longer Severe At Time of Death
and Did Not Last 12 Months
|
887 |
3 |
NH—Claim Filed After Death—Insufficient Evidence |
888 |
1 |
NH—Claim Filed After Death—Denial—Applicant Does |
889 |
2 |
Not Want To Continue Development of Claim NH—Claim Filed After Death—Denial—Impairment
Was Severe But Claimant Failed to Follow Prescribed Treatment
|
890 |
4 |
NH—Claim Filed After Death—Not Disabled At Any Time Earnings Requirement Met—Medical
Consideration Alone
|
891 |
4 |
NH—Claim Filed After Death—Not Disabled—Lack of Severity—Medical Consideration Alone |
892 |
2 |
DIB or CDB Medical Cessation |
893 |
2 |
DIB or CDB Cessation—Work Activity (No Trial Work Period) |
894 |
2 |
DIB or CDB Cessation—Whereabouts Unknown or Failure to Cooperate—Required Information
Not Submitted
|
895 |
2 |
DIB or CDB Cessation—Whereabouts Unknown or Failure to Cooperate—Requested Medical
Examination Not Taken
|
896 |
2 |
Disability Ends Prior to Beginning of Medicare Coverage |
897 |
None |
Disability Ends After Medicare Coverage Begins |
898 |
None |
CDB Reentitlement Notice |
899 |
1 |
Medicare Coverage Termination |
901 |
1 |
DWB Cessation—Medical Evidence Indicates Ability to Perform SGA |
902 |
2 |
Medicare Termination—Disability Ends Prior to Medicare Coverage |
903 |
None |
Medicare Termination—Disability Ends After Medicare Coverage Begins |
904 |
1 |
State Agency and M.D. Participation in Decision |
914 |
None |
Prior Freeze Not Affected by Current Denial |
916 |
None |
Periodic Review Scheduled |
917 |
None |
Lead-In Language for Closed Period and Later Onset Date Allowances |
918 |
None |
Disability Requirement and 7-Year Period Attachment |
919 |
None |
Disability and Earnings Requirement Attachment |
920 |
None |
Dual Entitlement—Subsequent Award—Medicare Awarded Previously and Will Continue on
First Account
|
940 |
None |