TN 23 (04-01)

A. POLICY – THE SEP AND PREMIUM SURCHARGE ROLLBACK FOR PREMIUM-HI

The SEP and premium surcharge rollback provisions apply to Premium-HI in the same way they apply to SMI. The premium surcharge rollback is applicable for the premiums payable by individuals enrolled in Premium-HI as aged or disabled under the conditions described for SMI in HI 00805.280.

The Premium-HI surcharge for late enrollment is limited by law to 10 percent no matter how late an individual enrolls in the program. Excluding months of GHP or LGHP coverage will either remove the surcharge completely or limit the period of time during which the surcharge must be paid.

B. EXAMPLE

Helen, who attained age 65 in 3/97, was covered under her husband"s GHP until he retired on 5/31/99 at age 61. Helen never worked under social security, but she meets the requirements for SMI and Premium-HI.

Although Helen could have enrolled under the SEP provisions at any time beginning 7/97 (the first month after the IEP), she did not apply until 4/99. She was awarded Premium-HI and SMI effective 6/99 based on her request. Her premiums are not increased for late enrollment because she was covered under a GHP all months after attaining age 65.

C. REFERENCES

• See HI 00801.131 for eligibility requirements for Premium-HI for the aged.

• See HI 00805.270 for general SEP eligibility requirements.

• See HI 00801.170 for those who are eligible for Premium-HI based on disability.