[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: 42CFR408.10]



[Page 275]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 408_PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE--Table of Contents

 

                      Subpart A_General Provisions

 

Sec. 408.10  Claim for monthly benefits pending concurrently with request 

for SMI enrollment.



    (a) If it is clear that an individual who applies for social 

security or railroad retirement benefits and for SMI will be entitled to 

monthly benefits, the application for monthly benefits is processed 

simultaneously with the request for SMI enrollment.

    (1) If monthly benefits are paid, the SMI premiums are deducted from 

those benefits.

    (2) If monthly benefits are suspended (for instance, because the 

individual's earnings exceed the maximum allowed by law), the enrollee 

is billed for direct remittance.

    (b) If it is clear that an individual will be entitled to SMI, but 

there is substantial question as to eligibility for monthly benefits, 

the request for SMI enrollment is processed separately.

    (1) When SMI enrollment is approved, the enrollee is billed for 

direct remittance.

    (2) When the application for monthly benefits is adjudicated, the 

following rules apply:

    (i) If monthly benefits are paid, the SMI premiums are deducted from 

those benefits, with appropriate adjustments for any premiums already 

paid by direct remittance.

    (ii) If the application for monthly benefits is approved but the 

benefits are suspended, the grace period is as set forth in Sec. 

408.8(a).

    (iii) If the application for monthly benefits is denied, the grace 

period is as set forth in Sec. 408.8(a)(1).



[52 FR 48115, Dec. 18, 1987, as amended at 56 FR 48112, Sept. 24, 1991]



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