TN 19 (03-93)

Citations:

Section 1837(d) of the Social Security Act

Regulations 42 CFR 407.14(b)

A. Background

The deemed IEP provision was instituted for individuals who missed their IEP (as established by SSA or RRB based on best evidence of age) because they relied on a document that led them to believe that they were not yet age 65.

B. Policy - General

Whenever a person believes, and there is documentary evidence indicating, that he or she was under age 65 during the IEP, a deemed IEP will be established.

For SMI (and Premium-HI) enrollment purposes, the individual is treated as though he or she attained age 65 at the time shown on the erroneous evidence. The premium surcharge for late enrollment (if any) is figured by counting the months beginning after the end of the deemed IEP.

C. Policy - Date of birth allegation

Where possible, the interviewer will obtain from the individual an allegation as to probable date of birth, even if it must be qualified as “uncertain.”

NOTE: Usually, an individual alleges a DB based on a document in his or her possession. Some individuals, however, may not know when they were born or have only the vaguest idea of how old they are.

The allegation is important because having a document agree with an allegation relieves SSA of the burden of “assigning” a DB for deemed IEP purposes. The interviewer never insists on an allegation for this purpose.

It may be possible to help an individual recall family or historical references which will enable that person to remember his or her birth date. Under no circumstances should an interviewer suggest a DB to the individual even if it seems the most likely DB based on the evidence at hand.

D. Policy - Evaluating evidence

1. Document not in individual's possession

If an individual alleges a DB based on evidence not in his or her possession, the document must be retrievable and must either agree with the alleged DB or at least show that the person was under age 65 during him/her IEP.

NOTE: It is more likely that a person relied on a document in his or her possession rather than on a record that has not been seen in years (e.g., a Form SS-5).

2. Weight to be accorded documents

In establishing a deemed DB, no particular weight is assigned to a document based on its formality or having been recorded early in life.

IMPORTANT: Where the individual does not know the correct DB (which would include the case where a DB is alleged but no evidence of that date is ever located), it is probable that various documents will show different dates of birth.

3. Usual situation

Rule a. in HI 00805.151 deals with the usual situation - an individual thinks he or she was born on a specified date in reliance on a document that is believed to be accurate. The reason for the person's belief that the document is accurate is not material to the determination of the deemed IEP. If the individual submits conflicting documents as to DB, the fact that he or she possesses a document and gives as his or her DB the DB shown on it is sufficient proof that he or she relied on that particular evidence, thus missing the IEP.

4. No real allegation of DB

Rules b., c., and d. in HI 00805.151 cover the rare but perplexing situations where an individual with various documents does not believe in the correctness of any of them, or alleges a DB for which there is no corroborating evidence, or is unable to allege a DB.

E. Policy - Filing after deemed IEP ends

Where an individual's deemed IEP ended before the month of current filing, the person will be deemed enrolled in the current GEP or, if filing in April-December and automatic enrollment is applicable, during the next GEP. Where automatic enrollment is not applicable (see HI 00805.050) and the individual files in April-December, he or she must enroll for SMI during the next GEP.

Only months after the end of the deemed IEP are charged against the enrollee in computing a premium increase based on enrollment during a GEP. If an erroneous surcharge comes to the attention of the DO or processing center, the enrollee's premium rate will be adjusted in accordance with HI 01001.010.

When an individual requests enrollment in a GEP and the FO record shows a prior enrollment attempt was denied because the individual was older than alleged and outside his enrollment period, an RC should be prepared to give the pertinent facts and alert the processing center about evidence previously submitted.

The claim should be clearly identified as an “Alleged Date of Attainment case” to alert the processing center to the need for special handling.