TN 31 (06-04)

A. Policy

A disabled qualified RR beneficiary (QRRB) is an individual whose D-HI coverage is under the jurisdiction of the RRB, but whose Medicare records are maintained by CMS. Many persons under age 65 to whom a RRB annuity is or could be paid, based on the person's permanent and total disability, may be entitled to D-HI beginning with the 25th month for which such annuity is or could be paid.

EXCEPTION: Section 115 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000, waives the 24-month waiting period for annuitants whose primary or secondary diagnosis is Amyotrophic Lateral Sclerosis (ALS). The Diagnosis code (either primary (DIG) or secondary (SDIG)) will be 3350.

These individuals are entitled to D-HI beginning 7/01 or the first month of disability benefit entitlement, whichever is later. If a beneficiary is diagnosed with ALS after his/her initial disability onset date and is within the 24-month Medicare waiting period, he/she is entitled to Medicare effective with the later of the ALS onset month or 7/01/01.

There are other individuals who, though entitled to an RRB annuity based on disability, will not qualify for HI. The reason is that the law provides that an individual must meet all the requirements of the SS Act which is, in certain respects, more stringent than the RR Act.

B. Procedure

Rather than attempt to explain the D-HI requirements in terms that would be correct for SSA-covered persons, refer to the RRB any career RR employees, their dependents, or survivors who inquire about HI for the disabled, if the potential applicant does not qualify for title II disability benefits.