Policy/Memo 36r1

Number: Policy Memo 36r1
Date Issued: May 14, 1990
Date Revised: December 14, 1992
Policy File Ref: A830

ISSUE:

Resolution of duplicate Medicare reimbursement situations.

Background:

Section 167a of Civil Service Law requires that reimbursement be provided to an enrollee for the cost of the Part B Medicare premium expense when the enrollee receives primary benefits from Medicare. In the past, enrollees who received reimbursement from both NYSHIP and another source were required to repay the NYSHIP reimbursement. If the enrollee failed to pay, the amount was taken from the enrollee's pension check.

A related issue involves the enrollee's or dependent's receipt of partial Part B reimbursement from another source. In this situation, the enrollee/dependent asks if either full or partial reimbursement is available from NYSHIP.

Policy:

In cases, where full duplicate Medicare reimbursement has been provided, terminate NYSHIP reimbursement on a current basis. Do not bill the enrollee for the period of duplicate reimbursement.

In cases where the enrollee or dependent receives partial reimbursement from another source, full NYSHIP reimbursement will be provided.