[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: 42CFR408.110]



[Page 286]

 

                         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 G_Collection of Unpaid Premiums; Refund of Excess Premiums After 

                        the Death of the Enrollee

 

Sec. 408.110  Collection of unpaid premiums.





    (a) Basis and scope--(1) Basis. Under the Federal Claims Collection 

Act of 1966 (31 U.S.C. 3711), CMS is required to collect any debts due 

it but is authorized to suspend or terminate collection action on debts 

of less than $20,000 when certain conditions are met. (See 4 CFR, parts 

101-105 for general rules implementing the Federal Claims Collection 

Act.) As indicated in Sec. 408.4, unpaid premiums are debts owed the 

Federal government by the enrollee or the enrollee's estate.

    (2) Scope. This section sets forth the methods of collection used by 

CMS and the circumstances under which CMS terminates or renews 

collection action. The regulations in this section apply to hospital 

insurance premiums as well as SMI premiums.

    (b) Collection of unpaid premiums. Generally, CMS will attempt to 

collect unpaid premiums by one of the following methods:

    (1) By billing enrollees who pay the premiums directly to CMS or to 

a designated agent in accordance with Sec. 408.60.

    (2) By deduction from any benefits payable to the enrollee or the 

estate of a deceased enrollee under Title II or XVIII of the Social 

Security Act, the Railroad Retirement Act or any act administered by the 

Office of Personnel Management in accordance with Sec. 408.4(b) and 

Subpart C of this part (Deduction from Monthly Benefits); or

    (3) By billing the estate of a deceased enrollee.

    (c) Termination of collection action. CMS terminates collection 

action on unpaid premiums under either of the following circumstances, 

if the cost of collection exceeds the amount of overdue premiums:

    (1) The individual is not entitled to benefits under the Acts listed 

in paragraph (b)(2) of this section, is not currently enrolled for SMI 

or premium hospital insurance, and demonstrates, to CMS's satisfaction, 

that he or she is unable to pay the debt within a reasonable time.

    (2) The individual has been dead more than 27 months (the maximum 

time allowed for claiming SMI benefits), and the legal representative of 

his or her estate demonstrates, to CMS's satisfaction, that the estate 

is unable to pay the debt within a reasonable time.

    (d) Renewal of collection efforts. CMS renews collection efforts in 

either of the following circumstances, if the cost of collection does 

not exceed the amount of the overdue premiums:

    (1) The individual enrolls again for premium hospital insurance or 

SMI. (Payment of overdue premiums is not a prerequisite for 

reenrollment.)

    (2) The individual becomes entitled or reentitled to social security 

or railroad retirement benefits or a Federal civil service annuity.