PM 22-07-01-a.

  1. (FCRC) Decide if the applicant or client is eligible for Qualified Medicare Beneficiary (QMB) benefits.
  2. (FCRC) Explain that the Department will pay the HIB premium beginning the date QMB starts, if they are eligible for QMB and are paying the HIB premium.
  3. (FCRC) Enter the Medicare claim number for each HIB beneficiary from the person's Medicare card or SOLQ response in Item 60 of Form 552.
  4. (FCRC) Enter the appropriate status indicator code following code HIB in Item 60 of Form 552.
    Definition Item 60 Code
    HIB Buy-in 1
    HIB Assumed 2
    HIB Enrolled 3
    HIB from BENDEX 4 

    Enter the effective date (MM/YYYY) between code HIB and the status indicator code in Item 60 of Form 552.

  5. (FCRC) Enter the gross income in Item 90 of Form 552 for SSA or Railroad Retirement benefits.
  6. (FCRC) Tell the client that SSA automatically refunds to them the premiums they paid for any month the Department makes the payment.
  7. (System) Matches HIB coding in Item 60 with the BENDEX Master File to verify HIB information.
  8. (System)Enters appropriate status indicator following code HIB for anyone who is a HIB beneficiary with no Item 60 code.
  9. (System)Generates Form 552 with the message BENDEX SMIB/HIB STATUS CHANGE.
  10. (SSA/CMS) Sends a notice to the client when the Department begins paying HIB premiums.

If a person loses QMB coverage:

  1. (CO) Stops paying HIB premiums the month QMB status ends. If the client has died, payments will stop the month after the month of death.

    NOTE: SSA continues HIB coverage for a person who loses QMB status. If a premium is charged, SSA bills the person.

    If the person does not wish to pay the HIB premium, they should notify the local SSA office. 

  2. (SSA/CMS) Notifies client that the Department has stopped paying HIB premiums.
  3. (FCRC) Send client Notice of Change (Form 157).
  4. (FCRC) Send Discrepancy Referral (Form 1925) to SSA/PCU.

If a person regains QMB status:

  1. (FCRC) Reenter on Form 552 in Item 60:
    • HIB and SMIB status indicator codes and dates,
    • QMB status indicator code, and
    • Medicare claim number.

Send Discrepancy Referral (Form 1925) to SSA/PCU.