TN 25 (04-12)

A. Policy for applying equitable relief

Beneficiaries age 65 or older or under age 65 and covered under a GHP based on the current employment status of a domestic (or life) partner are not spouses for SEP and premium surcharge rollback purposes. (For the definition of spouse and GHP, see HI 00805.266A.) However, under the equitable relief provisions, we permit these beneficiaries to enroll in Supplementary Medical Insurance (SMI) and premium Hospital Insurance (premium-HI) as if the SEP provisions still apply. Grant equitable relief to individuals who:

• Are age 65 or older or under age 65 and covered under a GHP based on the current employment status of a domestic (or life) partner and

• refused SMI (or did not enroll in premium-HI) and whose initial enrollment period (IEP) begins 12/2004 or earlier or enrolled in SMI (or premium-HI) during the IEP and voluntarily terminated coverage prior to 12/2004.

1. Evidence requirements

The individual must submit evidence of GHP coverage based on current employment as discussed in HI 00805.295.

2. SMI effective date

Determine the SMI and premium-HI effective dates in accordance with HI 00805.276 and HI 00805.285.

B. Example of SEP Enrollment

Mr. Jones attained age 65 in November 2004. He refused SMI coverage because he was covered under his partner’s group health plan (GHP). His partner, Mr. Smith, is working and the GHP includes domestic partner within the definition of spouse.

In October 2011, Mr. Jones contacts an SSA FO about enrolling in SMI because his partner is retiring January 1, 2012.

Since, we cannot recognize a domestic partner, age 65 or older, as a spouse, the SEP provisions no longer apply. Because Mr. Jones’ IEP begins 08/2004, he can enroll in SMI under the equitable relief provisions. He may enroll during any month in which he has coverage under the GHP based on his partner’s current employment or during the 8-month period that begins with the first full month after the GHP coverage based on current employment ends.

C. Reference

HI 00805.266 Definitions of Terms Used in the Special Enrollment Period and Premium Surcharge Rollback Provisions