[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: 42CFR407.25]



[Page 266-267]

 

                         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 B_Individual Enrollment and Entitlement for SMI

 

Sec. 407.25  Beginning of entitlement: Individual enrollment.



    The following apply whether an individual is self-enrolled or 

automatically enrolled in SMI:

    (a) Enrollment during initial enrollment period. (1) If an 

individual enrolls during the first three months of the initial 

enrollment period, entitlement begins with the first month of 

eligibility.

    (2) If an individual enrolls during the fourth month of the initial 

enrollment period, entitlement begins with the following month.

    (3) If an individual enrolls during the fifth month of the initial 

enrollment period, entitlement begins with the second month after the 

month of enrollment.

    (4) If an individual enrolls in either of the last two months of the 

initial enrollment period, entitlement begins with the third month after 

the month of enrollment.

    (5) Example. An individual first meets the eligibility requirements 

for



[[Page 267]]



enrollment in April. The initial enrollment period is January through 

July. The month in which the individual enrolls determines the month 

that begins the period of entitlement, as follows:



------------------------------------------------------------------------

 Enrolls in initial enrollment period        Entitlement begins on--

------------------------------------------------------------------------

January...............................  April 1 (month eligibility

                                         requirements first met).

February..............................  April 1.

March.................................  April 1.

April.................................  May 1 (month following month of

                                         enrollment).

May...................................  July 1 (second month after month

                                         of enrollment).

June..................................  September 1 (third month after

                                         month of enrollment).

July..................................  October 1 (third month after

                                         month of enrollment).

------------------------------------------------------------------------



    (b) Enrollment on reenrollment during general enrollment period. (1) 

if an individual enrolls or reenrolls during a general enrollment period 

before April 1, 1981 or after September 30, 1981, entitlement begins on 

July 1 of that calendar year.

    (2) If an individual enrolled or reenrolled during the general 

enrollment period between April 1, 1981 and September 20, 1981, 

entitlement began with the third month after the month in which the 

enrollment request was filed.

    (c) Enrollment or reenrollment during a SEP. The rules set forth in 

Sec. 406.24(d) of this chapter apply.



[53 FR 47204, Nov. 22, 1988, as amended at 61 FR 40347, Aug. 2, 1996]