[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: 42CFR407.1]



[Page 262-263]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 407_SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND ENTITLEMENT

--Table of Contents

 

                      Subpart A_General Provisions

 

Sec. 407.1  Basis and scope.









                      Subpart A_General Provisions



Sec.

407.1 Basis and scope.

407.2 General description of program.

407.4 Basic requirements for entitlement.



         Subpart B_Individual Enrollment and Entitlement for SMI



407.10 Eligibility to enroll.

407.11 Forms used to apply for enrollment under Medicare Part B.

407.12 General enrollment provisions.

407.14 Initial enrollment period.

407.15 General enrollment period.

407.17 Automatic enrollment.

407.18 Determining month of automatic enrollment.

407.20 Special enrollment period related to coverage under group health 

          plans.

407.22 Request for individual enrollment.

407.25 Beginning of entitlement: Individual enrollment.

407.27 Termination of entitlement: Individual enrollment.

407.30 Limitations on enrollment.

407.32 Prejudice to enrollment rights because of Federal Government 

          misrepresentation, inaction, or error.



                    Subpart C_State Buy-in Agreements



407.40 Enrollment under a State buy-in agreement.

407.42 Buy-in groups available to the 50 States, the District of 

          Columbia, and the Northern Mariana Islands.

407.43 Buy-in groups available to Puerto Rico, Guam, the Virgin Islands, 

          and American Samoa.

407.45 Termination of State buy-in agreements.

407.47 Beginning of coverage under a State buy-in agreement.

407.48 Termination of coverage under a State buy-in agreement.

407.50 Continuation of coverage: Individual enrollment following end of 

          coverage under a State buy-in agreement.



    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 

1302 and 1395hh).



    Source: 53 FR 47204, Nov. 22, 1988, unless otherwise noted.



[[Page 263]]







    (a) Statutory basis. The supplementary medical insurance (SMI) 

program is authorized by Part B of title XVIII of the Social Security 

Act.

    (1) Section 1831 of the Act establishes the program.

    (2) Sections 1836 and 1837 set forth the eligibility and enrollment 

requirements.

    (3) Section 1838 specifies the entitlement periods, which vary 

depending on the time and method of enrollment and on the basis for 

termination.

    (4) Section 1843 sets forth the requirements for State buy-in 

agreements under which States may enroll, and pay the SMI premiums for, 

eligible individuals who are also eligible for cash assistance or 

Medicaid.

    (5) Section 104(b) of the Social Security Amendments of 1965 (Pub. 

L. 89-87) specifies the limitations that apply to certain aliens and 

persons convicted of subversive activities.

    (b) Scope. This part sets forth the eligibility, enrollment, and 

entitlement requirements and procedures for supplementary medical 

insurance. (The rules about premiums are in part 408 of this chapter.)