POMS Reference

HI 00820: Terminations and Withdrawals

TN 9 (06-92)

A. POLICY - GENERAL

Premium-HI for the Working Disabled continues until the earliest of the:

  • End of the month following the month the individual is notified that he or she no longer has a disabling impairment.

  • End of the month following the month the individual files a request for termination of Premium-HI.

  • End of the month before the month the individual becomes re-entitled to premium-free HI. In this case:

    SMI coverage continues without interruption.

    The amount of the SMI premium reverts to the standard amount, effective with the first month of re-entitlement to premium-free HI, if the individual was paying a rate increased for late enrollment.

    IMPORTANT: Re-entitlement to disability benefits by an individual required to serve a new 24-month D-HI qualifying period does not result in termination of Premium-HI for the Working Disabled. Premium-HI entitlement continues (and a valid GEP or SEP enrollment may be filed) until the individual becomes re- entitled to premium-free HI based on meeting the 24-month qualifying period requirement.

  • End of the grace period for non-payment of premiums. (See
    HI 01001.095 for a discussion of grace period rules.)

  • Date of death.

B. POLICY — VOLUNTARY TERMINATION

Generally, the same considerations and limitations applicable to processing requests for termination of SMI coverage also apply to processing requests for termination of Premium-HI for the Working Disabled. (See HI 00820.045-HI 00820.070.)

C. PROCEDURE

If an individual indicates that he or she no longer wants Premium-HI for the Working Disabled because of inability to pay the Part A premium, explain the requirement that States pay Part A premiums for “qualified disabled and working individuals (QDWI).” Refer interested individuals to the appropriate State or local Medicaid agency for further information and enrollment.

NOTE: QDWIs are individuals entitled to Premium-HI for the Working Disabled whose income does not exceed 200 percent of the Federal poverty guidelines and whose resources do not exceed twice the SSI resource level.