BASIC (01-07)

Policy

The following apply to hospital insurance based on CDB entitlement:

For CDB beneficiaries, HI begins with the 25th month of entitlement to such benefits. Since entitlement to CDB can begin no earlier than age 18, HI based on entitlement to CDB can never begin earlier than the month the CDB beneficiary attains age 20. This is true even though an individual may have been disabled and entitled to child's insurance benefits for many months prior to age 18. Generally, HI for CDB beneficiaries will begin much later than age 20.

NOTE: For exceptions such as Amyotrophic Lateral Sclerosis (ALS) and End Stage Renal Disease, see DI 45605.001 and DI 45001.001.

EXAMPLE 1:

Sally, who was born 5/7/79, became totally disabled at age 5. In 9/90, when her father died, she became entitled to cash benefits on his earnings record. The 24-month qualifying period for HI begins with 5/97, the first month in which she attains age 18, and she can be entitled to HI no earlier than 5/99, the month she attains age 20, since that is the 25th month of her entitlement to a disability-based benefit.

EXAMPLE 2:

Arthur, born in 6/78, became entitled to child's benefits in 1990 when his father died. In 3/98 while attending college, he was severely injured in an accident and it was established that he was under a disability beginning 3/ 98. The first month for which he can be entitled to HI is 3/00, the 25th month of his CDB entitlement.

EXAMPLE 3: John was age 36 in 8/91 when his father, age 66, filed application for himself and John, disabled since birth. The CDB award was retroactive for 6 months to 2/91. Since John had never been previously entitled to disability benefits, his 24 month qualifying period begins 2/91 and he will be entitled to D-HI beginning 2/93.

NOTE: Specific information about entitlement to HI for the disabled and the 24-month qualifying period can be found in HI 00801.146.