PM 06-24-09
CANCELLATION DUE TO NONPAYMENT OF PREMIUM
Example 8: Mr. A's April premium is due by 03/20/08. If he does not pay his April premium by 04/20/08, his benefits will terminate effective 06/08.
Participants determined eligible for HBWD, whose benefits were terminated due to failure to pay a premium, must pay any past due premiums as well as their first monthly premium before HBWD benefits are re-authorized.
Example 9: Mr. A from the previous example does not pay his $25 April premium by 04/20/08. His case is terminated effective 06/08. He reapplies and is determined eligible again. His premium is still $25. Before HBWD benefits are authorized, he must pay his April premium of $25, his May premium of $25, and his new first monthly premium of $25 for a total of $75.
Enrolled Case
If an enrolled case fails to pay a premium timely:
- For a case with QMB, the system changes the case to QMB only with TA 31/TAR B4.
- For a case with SLIB, the system changes the case to SLIB only with TA 31/TAR B5.
- For a case that does not have QMB or SLIB, the system cancels the case with TA 22/TAR B7.
Active Case
If an active case fails to pay a premium timely:
- For a case with QMB, the system changes the case to QMB only with TA 31/TAR B6.
- For a case with SLIB, the system changes the case to SLIB only with TA 31/TAR B7.
- For a case that does not have QMB or SLIB, the system cancels the case with TA 22/TAR B3.
