POMS Reference

HI 00801: Hospital Insurance Entitlement

TN 28 (07-95)

Subject to the dialysis or transplant requirements in HI 00801.216 and HI 00801.221, entitlement to R-HI for an individual who meets the eligibility requirements in HI 00801.191 C. begins with the earliest of the following:

  • the third month after the month a regular course of renal dialysis begins (this period of non-coverage is called the qualifying or waiting period); or

  • the first month during which a regular course of renal dialysis begins if self-care dialysis training is begun before the qualifying period ends; or

  • the month of kidney transplant; or

  • the month of hospitalization as an inpatient in a Medicare-approved facility for procedures preliminary to a transplant, provided that the transplant occurs during one of the following two months; or

  • the second month prior to the month of kidney transplant if the inpatient procedures preliminary to the transplant took placemore than 2 months prior to the transplant; or

  • the first month during which a regular period of renal dialysis begins if the individual has had a previous period of R-HI entitlement.

Entitlement can never begin before the insured status requirement is met.

NOTE: R-HI may begin later in cases where the individual delays filing his/her application because of GHP coverage or the individual restricts the retroactivity of his/her application, see HI 00801.196.1