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HI 00901: Hospital Insurance Entitlement

Effective Dates: 02/10/2012 - Present

TN 2 (02-91)

Procedure

1. New Claims Case

When a beneficiary states that a new card has not been received, take the following steps:

Step Action

1

Examine the microfiche or temporary FO records to:

  • verify name, claim number, and entitlement; and

  • determine whether sufficent time has elapsed since the claim was forwarded (see HI 00901.085B).
2 If sufficient time elapsed, go to Step 3.
  If not, go to Step 4.

3

Transmit an HMQ (see SM 00706.005). When the replies are received, take one of the following actions:

  • If the MBR and HI records are correct,send a Health Insurance Query (HIC), or,

  • If either the MBR or HI or both are incorrect, follow procedures in HI 00930.001.
4 Inform the beneficiary when (s)he can expect to receive the card and advise him/her to recontact the FO if it is not received by then.
5 Issue a temporary notice of eligibility if appropriate. See HI 00801.500 - HI 00801.510.

2. Post-Entitlement Action

This table describes the FO action necessary when a beneficiary complains of nonreceipt of a replacement card prompted by a post-entitlement action (e.g., remarriage and SALT input):

Step Action

1

Verify that sufficient time has elapsed for the action to have changed the MBR and HI records. Sufficient time is:

  • 2 weeks if direct input was used and no exception was received.

  • 6 weeks if the change was a paper request to the PC.

2

If sufficient time elapsed, go to Step 3.

If not, go to Step 4.

3

Transmit an HMQ (see SM 00706.005). When the replies are received, take one of the following actions:

  • If the MBR and HI records are correct,send a HIC, or,

  • If either the MBR or HI or both are incorrect, follow procedures in HI 00930.001.
4 Inform the beneficiary when (s)he can expect to receive the card and advise him/her to recontact the FO if it is not received by then.
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