POMS Reference

HI 01001: Supplementary Medical Insurance

TN 22 (11-01)

The initial bill for an enrollee billed on a quarterly basis will cover premiums for months beginning with the first month of coverage and continuing through the third month following the month of billing; subsequent billings will be for 3 months. If several months of coverage elapse before the person is billed, it will increase the amount of premiums in a relatively short period, thus increasing the danger of nonpayment, termination of Supplementary Medical Insurance (SMI) coverage, and loss to the trust fund. Thus, to permit early establishment of SMI rights and prompt billing, develop and adjudicate enrollment applications as promptly as possible.

Example: If the enrollee's coverage began in 8/99, and the billing notice was sent in 9/99, the initial billing covered premiums for August and September plus the ensuing 3 months (10/99-12/99). Thus, the enrollee was asked to pay 5 months' premiums on the initial notice. Thereafter, the enrollee will be billed quarterly for 3 months' premiums