HI 00801.032 Establishing Entitlement
A. PROCESS — INITIAL ENTITLEMENT CASES
HI entitlement for a monthly beneficiary is established using the same SSN and BIC used for payment of the monthly benefit. HI entitlement for an individual eligible for but not currently entitled to monthly benefits is established under the claimant"s own SSN (even if the claimant"s HI entitlement is based on another person"s earnings). The BIC of “T” is used to identify individuals who file for HI only.
Once the HI entitlement date is established on the Master Beneficiary Record (MBR), it is subsequently passed along to CMS"s health insurance system for entry onto the Health Insurance Master Record and for preparation of a health insurance card. The SSA award certificate will advise the individual of his/ her HI entitlement date and explain that the award certificate may be used as proof of Medicare entitlement until receipt of a health insurance card.
If a person is filing on their own work record, then their Medicare claim number is their own social security number with the letter A. If they are not currently receiving benefits on their own record then the letter is different depending on the circumstances. Please see below for some additional subscripts.
TN 1 (06-86)GN 01050.017 Additional Subscripts
Additional subscripts are used when:
- more than one child files on the same E/R; or,
- more than one individual files for the same type of auxiliary or survivor benefit on the same E/R (e.g., more than one person filing as the legal wife); or,
- more than one individual whose entitlement is based on a marital relationship to the wage earner files for auxiliary or survivor benefits on the same E/R even though they file for different types of such benefits; or,
- more than one individual files for special age 72 payments on the same E /R; or,
- more than one individual or organization files for the lump-sum death payment on the same E/R.
The subscripts serve to identify the type of claim and to classify the status of the individual who filed. The subscripts are assigned in ascending order. For this purpose, it is immaterial whether the multiple filings are simultaneous or sequential.
When multiple filings occur on the same day, special rules for each letter code are provided in 1-4 below.
Subscripts have been provided for five or more claimants in each letter code which needs such extension. If, in a particular case, no claims symbol with an appropriate subscript as described below is available, the processing center should forward the claims folder directly to the Office of Retirement and Survivors Insurance.
B. Subscript Explanation
1. “C” CLAIMANTS
Subscripts for “C” claimants are originally assigned in sequence of age, C1 for the youngest child, C2 for the next youngest child, etc. Additional claimants after C9 will be assigned alphabetical subscripts, e.g., CA instead of C10, CB instead of C11, etc. When subscripts have been assigned to child claimants whose claims have been forwarded to a processing center and an application is filed on behalf of an additional child, the next unused number or letter will be used as the child's subscript, regardless of age.
2. WIFE, DIVORCED WIFE, WIDOW, MOTHER, SURVIVING DIVORCED WIFE, AND SURVIVING DIVORCED MOTHER
1st Claimant2nd Claimant3rd Claimant 4th Claimant5th Claimant
Wife Age 62 or OlderBB3B8BABD Wife Under Age 62B2B5B7BKBL Divorced WifeB6B9BNBPBQ Widow Age 60 or OlderDD2D8DDDG Widow Remarried After Age 60D4D9DADLDN Surviving Divorced WifeD6D7DVDWDY MotherEE2E7E8EA Surviving Divorced MotherE1E3EBECED
NOTE: When claims for the same or different types of benefits (auxiliary or survivor) are filed, all based on a marital relationship to the wage earner, use as type of benefit the letter codes reflected beside the type of relationship above. The first individual to file should be assigned type of benefit B, B2, B6, D, D4, D6, E, or E1 as appropriate. The second individual should be assigned a type of benefit in the second claimant column, etc. Under no circumstances should two individuals be assigned letter codes in the same claimant column. At no time, after the assignment of a letter code in one column, should the individual be assigned a code in a different multiple claimant column. See Example 2 below in which Della Burger was originally assigned the symbol HB7 and when she later filed for a different type of benefit based on marital relationship, was assigned symbol D8. The types of benefits are different. The subscript was selected from the same claimant column. If more than one claimant files on the same day, use the dates of marriage to determine the subscripts, with the earliest date of marriage designating the first claimant. Failure to follow these rules will result in the award being an exception. For this reason the DO should carefully examine the microfiche/MBR whenever a subsequent claim based upon marital relationship is filed in order to insure that the proper BIC is assigned.
Dora Canard, age 65, and Jane Canard, age 70, both file on the same day. Each alleges that she is the legal wife of Donald Canard. Dora presented a certificate showing her date of marriage to Donald Canard was June 2, 1935. Jane's certificate showed she was married to Donald Canard on January 15, 1960. Dora's claim symbol is B. Jane's is B3.
Hamilton Burger became entitled to disability benefits and wife, Arabelle, age 45, became entitled with a claims symbol of HB2. She died and Hamilton married Viola who filed for wife's benefits and was assigned claims symbol HB5. She was subsequently terminated when the youngest child reached age 18. She divorced Hamilton who married Della, age 50, shortly thereafter. Della filed for wife's benefits but had no children in her care and was denied. Her claims symbol was HB7. The NH died. Gertie, age 60, established entitlement as his legal widow. She would be assigned claims symbol DD. A short time later, Cleo, age 62, filed claiming to be the legal widow. Her claim symbol would be DG. If Della filed again, claiming to be the legal widow, her claim symbol would be D8.
3. DISABLED WIDOWS, DISABLED WIDOWERS, DISABLED SURVIVING DIVORCED WIVES, AND DISABLED SURVIVING DIVORCED HUSBAND
The claim symbol and subscripts for all “W” claimants will be shown as follows:
1st Claimant2nd Claimant3rd Claimant4th Claimant5th Claimant
Disabled WidowWW2W4W9WF Disabled WidowerW1W3W5WBWG Disabled Surviving Divorced WifeW6W7W8WCWJ Disabled Surviving Divorced HusbandWRWT
See the Note and examples in B.2. above for a further discussion of the assignment of subscripts when more than one claimant files for benefits based on a marital relationship to the NH on the same E/R.
4. HUSBAND, DIVORCED HUSBAND, WIDOWER, FATHER, SURVIVING DIVORCED FATHER, AND SURVIVING DIVORCED HUSBAND
1st Claimant2nd Claimant3rd Claimant
Husband Age 62 or OlderB1B4BGBHBJ Divorced HusbandBRBT HusbandBYBW Widower Age 60 or OverD1D3DHDJDK Widower RemarriedD5DPDQDRDT Surviving Divorced HusbandDCDMDSDXDZ FatherE4E6EFEGEH Surviving Divorced FatherE5E9EJEKEM
The discussion contained in the Note and examples in B.2. above also apply to male claimants for the benefits listed in this subsection.
5. SPECIAL AGE-72 PAYMENTS
Spouse1st Claimant2nd Claimant3rd Claimant4th Claimant5th Claimant
Entitled to HIB (less than 3 QC's)K1K5K9KDKH Entitled to HIB (3 QC's or more)K2K6KAKEKJ Not Entitled to HIB (less than 3 QC's)K3K7KBKFKL Not Entitled to HIB (3 QC's or more)K4K8KCKGKM
See the Note and examples in B.2. above for a further discussion of the assignment of subscripts when more than one spouse files for the Special Age-72 payments on the same E/R.
The following subscripts are added in claims for parent's benefits:
- F1 Father
F5 Adopting Father
F6 Adopting Mother
If a second alleged father files, subscript “7” will be used, if a second mother, subscript “8.”
7. CLAIMANTS FOR THE LUMP-SUM DEATH PAYMENT
For lump-sum death payment claimants, subscripts are assigned in the order of time of filing. If the applications are filed at the same time, it is immaterial which one is considered as having been filed first. Where two or more fiduciaries file for an LSDP on behalf of the same estate, they will be treated as one claimant.
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GN 01050.017 - Additional Subscripts - 12/22/1989
Batch run: 01/27/2009