HI 00805: Supplementary Medical Insurance Entitlement
TN 19 (03-93)
A. Policy - General
The beginning of an individual's SMI coverage period depends on the enrollment period and the month in which he/she enrolls, or is deemed enrolled.
B. Policy - IEP enrollment
For an individual who first meets the eligibility requirements of HI 00805.005 on or after 3/1/66 and enrolls in the IEP (see HI 00805.015), the beginning of the SMI coverage period is related to the month of enrollment, as follows:
1. Before first month of eligibility
If an individual enrolls in the 3 months prior to the first month of eligibility for SMI, the coverage period will begin on the first day of the month of eligibility.
2. In first month of eligibility
If an individual enrolls in the first month of eligibility, the coverage period begins with the first day of the next month.
3. In the month following the month of first eligibility
If an individual enrolls in the month following the first month of eligibility, the coverage period begins with the first day of the second month following the month in which he/she enrolls.
EXAMPLE: If a person first meets the requirements in June and enrolls in July, the coverage period begins the first day of September.
4. In last 2 months of the IEP
If an individual enrolls in the last two months of the IEP, the coverage period begins the first day of the third month following the month of enrollment.
EXAMPLE: If a person first meets the requirements in June and enrolls in August, the coverage period begins the first day of November. If enrollment is in September, the coverage period begins on the first day of December.
5. Overriding rules
No coverage could begin before 7/1/66. All persons eligible before 6/66 and enrolling before 6/66, had SMI coverage beginning 7/1/66.
C. Description of IEP enrollment
The following chart (valid for persons first eligible after June 1966) illustrates the situations in B.1 - B.4., above.
D. Policy - GEP enrollment
If an individual enrolls or re-enrolls during a GEP (January through March), but after the IEP, the SMI coverage period begins July 1 of the year of enrollment.
E. Policy - Equitable relief
Because of the problems caused by retroactive SMI entitlement, in many equitable relief cases (see HI 00805.170ff.), an individual's SMI entitlement may begin with the month in which the SMI award is processed rather than a much earlier date based on the time of enrollment.
F. References
SMI entitlement for persons enrolled on the basis of end stage renal disease, HI 00805.045
SMI coverage period for those who meet the applicable requirements in HI 00805.270 for a special enrollment period, HI 00805.275