Enter the effective date (MM/YYYY) between code HIB and the status indicator code in Item 60 of Form 552.
If a person loses QMB coverage:
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.
If a person regains QMB status:
Send Discrepancy Referral (Form 1925) to SSA/PCU.
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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