HI 00801: Hospital Insurance Entitlement
Preliminary questions during the initial interview with a prospective claimant should reveal whether an application for monthly RSI benefits or an SSA-18F5 should be filed. In any doubtful case, obtain an SSA-18-F5 and a supplemental statement, if needed, to determine possible entitlement to monthly benefits or eligibility for RSI. If an SSA-18F5 is filed for an insured individual, it will often be possible to adjudicate the RSI claim without further development. The application item concerning the claimant's agreement to report deduction and termination events can be obtained after adjudication.
An interested person may file for deemed insured HI on behalf of an incompetent individual or an individual who is physically unable to execute an application. Since representative payee development will not be undertaken in these cases, medical evidence describing the individual's condition will not normally be available. To establish that the interested person is a proper applicant in accordance with GN 00204.003, he should complete a signed statement describing the individual's condition and his relationship to him (or other basis for acting on his behalf). If such statement raises any doubt that the individual is incompetent or that the interested person is a proper applicant, evidence should be obtained to resolve the issue.