[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR406.33]



[Page 260-261]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 406_HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT--Table of Contents

 

                  Subpart C_Premium Hospital Insurance

 

Sec. 406.33  Determination of months to be counted for premium increase: 

Enrollment.



    (a) Enrollment before April 1, 1981, or after September 30, 1981. 

The months to be counted for premium increase are the months from the 

end of the initial enrollment period through the end of the general 

enrollment period, the special enrollment period, or the transfer 

enrollment period in which the individual enrolls, excluding the 

following:

    (1) Any months before September 1973.

    (2) For premiums due for months after May 1986, any months beginning 

with January 1983 during which the individual was enrolled in an 

employer group health plan based on the current employment of the 

individual or the individual's spouse.

    (3) Any months during the 7-month special enrollment period under 

Sec. 406.21(e) during which premium hospital insurance coverage is in 

effect.

    (4) Any months that the individual was enrolled in an HMO or CMP 

under part 417, subpart K of this chapter as described in Sec. 

406.21(f).

    (b) Enrollment during the period April 1 through September 30, 1981. 

The months to be counted for premium increase are the months from the 

end of the initial enrollment period through the month in which the 

individual enrolled, excluding any months before September 1973.

    (c) Examples. (1) John F's initial enrollment period ended July 1979 

but he did not enroll until January 1980. The months to be counted are 

August 1979 through March 1980. Since only 8 months elapsed, there is no 

premium increase.

    (2) Mary T's initial enrollment period ended in April 1980 but she 

did not enroll until May 1981. The months to be counted are May 1980 

through May 1981. Since 13 months has elapsed, the premium would be 

increased by 10 percent.

    (3) Effective with July 1986, Mary T, in Example 2, would no longer 

have to pay an increased premium because she had paid it for twice the 

number of full 12-month periods during which she could have been, but 

was not, enrolled in the program.

    (4) Vincent C's initial enrollment period ended August 31, 1986. He 

was covered under his wife's employer group health plan until she 

retired on May 31, 1989. He enrolled during June 1989, the first month 

of the special enrollment period under Sec. 406.21(e). No months are 

countable for premium increase purposes because the exclusions of 

paragraph (a) of this section apply to all months.

    (5) Terry P enrolled in the 1987 general enrollment period, with 

coverage effective July 1987. There were 28



[[Page 261]]



months after the end of his initial enrollment period through the end of 

the 1987 general enrollment period. His premium is increased by 10 

percent. The increase will be eliminated after he has paid the 

additional 10 percent for 48 months.



[48 FR 12536, Mar. 25, 1983. Redesignated at 51 FR 41338, Nov. 14, 1986, 

as amended at 53 FR 47203, Nov. 22, 1988. Further redesignated and 

amended at 57 FR 36014, Aug. 12, 1992]