Subchapter Preview:

Regulations No 4. 404.350-404.369, 404.603, 404.701-404.780, 404.1501-404-1599,

BASIC (01-07)

The provisions of title II of the Social Security Act, Section 202(d), Child's Insurance Benefits (CDB), are contained in RS 00203.001.

A. Definition

Requirements for entitlement to CDB benefits are as follows:

• The definition of disability for CDB cases is the same as for Disability Benefits DIB) cases. See DI 10105.065.

• A CDB does not have to serve a waiting period prior to entitlement.

• Instructions on conducting the disability interview are contained in DI 11005.001.

NOTE: For months prior to 1/73, the law provided that the disability must have begun prior to age 18.

B. Policy – CDB Entitlement Factors – General

The following are entitlement factors for CDB:

• Child’s insurance benefits may be payable for months in which the child is age 18 or over and is under a disability which began before age 22.

• Child’s benefits may be payable based on a disability which began after age 22 if the disability began before the close of the 84 months period following the month in which the child’s most recent entitlement to benefits as a CDB terminated because his/her disability ceased.

• If an inquiry regarding CDB benefits is made on behalf of a child who is entitled to child's benefits and may meet the disability requirement, but is under age 17 1/2, tell the inquirer or the payee to contact the District Office (DO) when the child reaches 17 1/2 unless the child's disability is material for the entitlement of a mother or father beneficiary.

C. Policy – CDB Entitlement Requirements

Below is a list of requirements to be eligible for CDB benefits. The child must:

• Be the child of a wage earner (WE) entitled to a RIB or a DIB, or of a WE who died fully or currently insured after 3/31/38.

• Be dependent upon the WE. (See GN 00306.006 and GN 00306.009 for a discussion of dependency and the time the dependency requirement must be met.)

• Have filed application for child's benefits, except as provided in RS 00203.001.

• Be unmarried. (See RS 00203.020 for situations in which a child who has been married may nevertheless be eligible for benefits.)

• Be under a disability which began before age 22.

1. The Following Must be Considered When Requirements Are Met

When a child meets all of the above requirements for entitlement on the E/R of a living WE, he/she may not be entitled to a monthly benefit until all requirements are met throughout the entire month. See RS 00203.010 for a discussion of the first month of entitlement (MOET) requirements in life cases. If a child meets all the requirements for entitlement on the E/R of a deceased WE, he/she is entitled that same month and the throughout the entire month rule does not apply. See RS 00203.005.

2. The Following Must be Considered When Requirements Are Not Met:

Even though a child no longer meets all of the above requirements, entitlement can be established for months in the retroactive period of his/her application in which all of the requirements are met. For example, a child who is married when his application is filed may be entitled for months in the retroactive period before the month of his marriage.

D. Policy- CDB Non Entitlement

Even though a CDB may meet the requirements in DI 10115.001C, entitlement is precluded if:

• The Railroad Retirement Board (RRB) has jurisdiction over the survivor’s claims (see RS 01601.150 – RS 01601.170), or

• The child was convicted of the felonious and intentional homicide of the number holder (NH), or was found to have killed the NH by an act which, if committed by an adult, would be considered a felony. (See GN 00304.070 and RS 00203.001).

E. Policy – CDB Entitlement to Other Benefits

1. HI/SMI Entitlement

Entitlement to hospital insurance (HI) benefits for a child, beginning with the 25th consecutive MOET (starting 7/73 or later), may be determined if the child is entitled based on a disability and has been entitled as a disabled child for 24 consecutive calendar months.

2. Other Benefit Entitlement

The following are other benefit entitlement criteria:

• Eligible for the supplementary medical insurance program at the same time. See HI 00801.146 and DI 10115.015 for a discussion of this provision.

• If a CDB claimant has a Social Security Number (SSN) or may have worked, he/she may be entitled to a DIB or Supplemental Security Income (SSI) on his/her own SSN. A certified earnings record (E/R) must be obtained for the CDB's own SSN (see SM 00349.001).

• A child age 18 or over and disabled may, at the same time, be entitled to a child’s insurance benefit and another benefit (See RS 00203.040 where a child is entitled to child’s insurance benefits on more than one E/R).

• If the other benefit is not a DIB or RIB, the child is eligible to receive only the higher benefit.

• If the other benefit is a DIB or RIB, the child’s benefit is reduced by the amount of the DIB or RIB.

F. Policy – CDB Entitlement & Retroactivity

The following apply to CDB Entitlement & Retroactivity:

• Retroactivity of an application for CDB benefits or for health insurance on the record of a non-DIB claimant is limited to 6 months.

• If the CDB is entitled on the ER of an individual entitled to DIB, as much as 12 months retroactivity is provided. (See GN 00204.030 and HI 00801.146C.)

G. Policy – CDB Payment Deductions

The following apply to CDB Payment Deductions:

• A CDB is subject to deductions if the child refuses without good cause to accept vocational rehabilitation (VR) services unless the child is a full-time student. See DI 13501.000 for a discussion.

• Work deductions are not imposed against a CDB because of work by the child, but work deductions incurred by the WE will have the same effect on a CDB as on any other auxiliary.

• If a CDB marries a WE entitled under the RSI provisions, the CDB is subject to deductions occasioned by the WE's work with all deductions being computed as though the CDB was entitled to husband's or wife's benefits on the WE's E/R.

H. Policy- CDB Cessations

The following provide more information on CDB cessations:

• GN 02607.160 provides a discussion of suspension of benefits to prisoners and GN 02607.200 specify other conditions under which there may be exceptions to the suspension.

  NOTE: Effective 4/1/00, benefits to a CDB are suspended if the beneficiary was convicted of a criminal offense and confined to a penal institution for more than 30 continuous days.

• RS 00203.035 contains a consolidated list of the terminating events that apply to child's benefits. Death terminates all types of child's benefits. Marriage terminates benefits of disabled children age 18 and over as well as benefits of children under 18 and students; except when the marriage is to another Social Security beneficiary. See RS 00203.035A.3.

• A CDB ends with the second month following the month in which the child has ceased to be under a disability. (The trial-work provision discussed in DI 13010.035 applies to a CDB.)

• A CDB also ends with the termination of the WE's entitlement if he/she was entitled to a DIB, unless his/her entitlement terminated because of death or entitlement to RIB.

• The first months of SGA level earnings after the end of the reentitlement period if the disability ceased due to the performance of SGA and the CDB is eligible for the extended period of eligibility (EPE provisions – see DI 13010.210).

• Termination of child's benefits based on disability because of cessation of disability is subject to the same provisions as are applicable to DIB. However, child's benefits may, nevertheless, be payable until age 19 if the child is a full-time elementary or secondary school student (as defined by the 1981 amendments).