Policy/Memo 82r2

Number: Policy Memo 82r2
Date Issued: January 30, 1996
Date Revised: November 14, 2017
Policy File Ref: A830
Subject: Retroactive Medicare Part B Reimbursements for New York State and Participating Employers' Enrollees and their Dependents

ISSUE:

Determine the maximum period of retroactive reimbursement for Medicare Part B premiums when NYSHIP has been paying primary for a Medicare enrolled person.

Purpose:

Determine the process that takes place when the Employee Benefits Division (EBD) discovers a New York State or Participating Employer’s enrollee or dependent who has not received Medicare Part B reimbursements that he or she is entitled to.

Background:

Employers participating in NYSHIP are required to reimburse the cost of Medicare Part B for enrollees and dependents in accordance with Section 167-a of Civil Service Law. Occasionally, EBD owes retroactive Medicare Part B reimbursements to individuals because EBD was not informed that they were Medicare-primary.

Policy:

When EBD becomes aware that an individual’s claims have been paid Medicare-primary, Medicare reimbursement will begin on the most recent of the following events:

• Retirement date;

• Medicare Part B eligibility date;

• First day of the month following the last primary claims payment by the Empire Plan or an HMO; or

• Three years prior to the date EBD discovers the problem (in accordance with Section 8 of State Finance Law).

The “Med Prmy” indicator on the NYBEAS record will reflect the date the enrollee became Medicare primary and should have enrolled in Medicare Part B.

The “Med Reimb” indicator will reflect the date NYSHIP will allow retroactive Medicare Part B reimbursement to begin.

The Empire Plan carriers or HMO will receive a letter informing them of this decision so that their claims files can be reprocessed.