HI 01001: Supplementary Medical Insurance
A. General
This instruction applies only to SSA beneficiaries whose benefits have been certified to RRB for payment (RR cert cases). When the beneficiary becomes involved in equitable relief situations, RRB will notify him of the possible options available in the same way SSA notifies its beneficiaries. However, when an RRB beneficiary disagrees with the determination or requests waiver of premiums, SSA is responsible for developing the possible waiver of premiums or informing RRB of the method of recovering a premium arrearage. RRB will use form RR-9, “SS Benefit Overpayment and SMI Premium Arrearage Transmittal” (see HI 01001.383) to transmit the case and attach any correspondence from the beneficiary pertaining to his request or protest.
B. Processing
Basically, the equitable relief situations sent by RRB will be handled in accordance with HIIM 1085ff. The reply to RRB will be returned on the “Memorandum to RRB for Premium Arrearages Based on Equitable Relief” (see HI 01001.384).
1. REQUEST FOR WAIVER
When an RRB requests waiver of a premium arrearage, follow HIIM 1085.03. Send the request to the district office via a form SSA-5075 with any documentation sent by RRB. Send the district office's determination to RRB on HI 01001.384.
2. PROTEST OF ANY REPAYMENT
If a beneficiary protests the repayment of an arrearage, inform RRB to offer him the option of paying in installments. Also, tell RRB that if the beneficiary refuses any type of repayment, action must be taken to recover the premiums. If the beneficiary is in currentpay, the amount should be deducted from his benefits. If the beneficiary is being billed for premiums, tell RRB to send a bill in the amount of the arrearage. RRB should notify the beneficiary of any actions it is taking as described in the various situations in HIIM 1085ff (e.g., HIIM 1085.07, HIIM 1085.10, and HIIM 1085.12). It will be necessary to describe to RRB what to tell the beneficiary since they do not have access to the HIIM.