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Centers for Medicare & Medicaid Services, HHS § 408.

408.62 Initial and subsequent billings. lations to establish when an individ-
408.63 Billing procedures when monthly ben- ual’s coverage ends because of non-
efits are less than monthly premiums.
408.65 Payment options.
payment of premiums. It also specifies
408.68 When premiums are considered paid. that those regulations may provide a
408.70 Change from quarterly to monthly grace period for payment of overdue
payments. premiums without loss of coverage.
408.71 Change from deduction or State pay- Section 1839 sets forth the specific pro-
ment to direct remittance. cedures for determining the amount of
Subpart E—Direct Remittance: Group the monthly premium and section 1840
Payment establishes the rules for payment of
premiums. Section 1843 provides that a
408.80 Basic rules. State may enter into a buy-in agree-
408.82 Conditions for group billing. ment to secure SMI coverage for cer-
408.84 Billing and payment procedures.
408.86 Responsibilities under group billing tain individuals by enrolling them in
arrangement. the SMI program and paying the pre-
408.88 Refund of group payments. miums on their behalf. Section 1881(d)
408.90 Termination of group billing arrange- provides that Medicare payment, for
ment. the reasonable charges incurred in con-
408.92 Change from group payment to de-
duction or individual payment.
nection with a kidney donation, shall
be made (without regard to deductible,
Subpart F—Termination and Reinstatement premium, or coinsurance provisions of
of Coverage title XVIII) as prescribed in regula-
408.100 Termination of coverage for non-
payment of premiums.
(b) The Federal Claims Collection
408.102 Reconsideration of termination. Act (31 U.S.C. 3711), as implemented by
408.104 Reinstatement procedures. 4 CFR parts 101–105, provides the basic
authority for recovery of debts owed
Subpart G—Collection of Unpaid Pre- the United States government and
miums; Refund of Excess Premiums specifies the conditions for the suspen-
After the Death of the Enrollee sion or termination of collection ac-
408.110 Collection of unpaid premiums. tion. Departmental regulations at 45
408.112 Refund of excess premiums after the CFR part 30, updated by a final rule
enrollee dies. published on January 5, 1987 (52 FR 260)
set forth procedures for the exercise of
Subpart H—Supplementary Medical the Department’s authority to collect
Insurance Premium Surcharge Agreements and dispose of debts and were intended
Sec. to complement rules applicable to par-
408.200 Statutory basis. ticular programs. CMS rules are set
408.201 Definitions. forth at 42 CFR part 401, subpart F.
408.202 Conditions for participation.
408.205 Application procedures. [52 FR 48115, Dec. 18, 1987; 53 FR 4158, Feb. 12,
408.207 Billing and payment procedures. 1988, as amended at 56 FR 48112, Sept. 24,
408.210 Termination of SMI premium sur- 1991]
charge agreement.
AUTHORITY: Secs. 1102 and 1871 of the Social § 408.2 Scope and purpose.
Security Act (42 U.S.C. 1302 and 1395hh). (a) This part sets forth the policies
SOURCE: 52 FR 48115, Dec. 18, 1987, unless and procedures for determining the
otherwise noted. amount of monthly supplementary
medical insurance (SMI) premiums, for
Subpart A—General Provisions the payment, collection, or refund of
premiums, for termination of coverage
§ 408.1 Statutory basis. because of nonpayment of premiums,
(a) This part implements certain pro- and for reinstatement of coverage if
visions of sections 1837 through 1840 certain conditions are met. It conforms
and 1881(d) of the Social Security Act to subpart C of part 407 of this chapter,
(the Act) and conforms to other regula- which sets forth the requirements for
tions that implement section 1843 of State buy-in agreements. These poli-
the Act. Section 1838(b) requires regu- cies are intended to protect enrollee


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§ 408.3 42 CFR Ch. IV (10–1–02 Edition)

coverage to the maximum degree com- (2) A kidney donor who is an enrollee
patible with maintaining the integrity is not relieved of the obligation for pre-
of the SMI program. miums.
(b) Policies that apply to premiums [52 FR 48115, Dec. 18, 1987; 53 FR 4159, Feb. 12,
that certain individuals must pay in 1988]
order to become entitled to Medicare
Part A hospital insurance benefits, are § 408.6 Methods and priorities for pay-
set forth in part 406 of this chapter. ment.
[52 FR 48115, Dec. 18, 1987; 53 FR 4159, Feb. 12, (a) Methods of payment—(1) General
1988] rules. Premiums are paid by one of the
following four methods:
§ 408.3 Definitions. (i) Payment by a State under a buy-
As used in this part, unless the con- in agreement.
text indicates otherwise— (ii) Deduction from monthly railroad
Enrollee means an individual who is retirement of social security cash ben-
efits or Federal civil service annuities.
enrolled in the SMI program under
Medicare Part B. (iii) Direct remittance on an indi-
vidual basis, by or on behalf of the en-
Taxable year means the 12-month pe-
riod (calendar or fiscal year) for which
(iv) Direct remittance on a group
the individual files his or her income
basis, by an employer, union, lodge or
tax return. other organization, or by an entity of
§ 408.4 Payment obligations. State or local government.
(2) Special situations. (i) If the month-
(a) Month for which payment is due. (1) ly social security benefit or age 72 spe-
A payment is due for each month, be- cial benefit is less than the monthly
ginning with the first month of SMI premium, the benefit is withheld and
coverage and continuing through the the enrollee is required to pay the bal-
month of death or, if earlier, the ance through direct remittance. (This
month in which coverage terminates. situation may arise if the individual
(2) A premium is due for the month of first becomes eligible for social secu-
death, if SMI coverage is still in effect, rity benefits after December 31, 1981,
even though the individual dies on the and is, therefore, not eligible for the
first day of the month. fixed minimum, or receives age 72 spe-
(b) Overdue premiums. (1) Overdue pre- cial benefits that are reduced because
miums constitute an obligation en- the individual receives a government
forceable against the enrollee or the pension.)
enrollee’s estate. (ii) If the monthly railroad retire-
(2) Overdue premiums are collected— ment benefit or civil service annuity
payment is less than the premium, the
(i) By deduction from social security
monthly payment is not withheld and
or railroad retirement benefits or Fed- the enrollee is required to pay the total
eral civil service annuities; premium by direct remittance.
(ii) Directly from the enrollee or the (b) Priorities for payment. (1) If an en-
enrollee’s estate; or rollee is enrolled under a State buy-in
(iii) By offset against any SMI pay- agreement—
ments payable to the enrollee or the (i) SMI premiums may not be de-
enrollee’s estate. ducted from monthly cash benefits or
(3) Interest is not charged on overdue annuities; and
premiums, except under a State buy-in (ii) The enrollee may not be required
agreement, as provided in § 408.6(c)(4). to pay by direct remittance.
(c) Premiums not required for certain (2) If an enrollee is not covered under
kidney donors. (1) No premiums are re- a State buy-in agreement, but is re-
quired for SMI benefits related to the ceiving a monthly benefit or an annu-
donation of a kidney if the donor is not ity specified in paragraph (a)(1)(ii) of
an enrollee. this section—


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