- (FCRC) Decide if the applicant or client is eligible for Qualified Medicare Beneficiary (QMB) benefits.
- (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.
- (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.
- (FCRC) Enter the appropriate status indicator code following code HIB in Item 60 of Form 552.
||Item 60 Code|
|HIB from BENDEX
Enter the effective date (MM/YYYY) between code HIB and the status indicator code in Item 60 of Form 552.
- (FCRC) Enter the gross income in Item 90 of Form 552 for SSA or Railroad Retirement benefits.
- (FCRC) Tell the client that SSA automatically refunds to them the premiums they paid for any month the Department makes the payment.
- (System) Matches HIB coding in Item 60 with the BENDEX Master File to verify HIB information.
- (System)Enters appropriate status indicator following code HIB for anyone who is a HIB beneficiary with no Item 60 code.
- (System)Generates Form 552 with the message BENDEX SMIB/HIB STATUS CHANGE.
- (SSA/CMS) Sends a notice to the client when the Department begins paying HIB premiums.
If a person loses QMB coverage:
- (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.
- (SSA/CMS) Notifies client that the Department has stopped paying HIB premiums.
- (FCRC) Send client Notice of Change (Form 157).
- (FCRC) Send Discrepancy Referral (Form 1925) to SSA/PCU.
If a person regains QMB status:
- (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.