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Policy/Memo 94

Number: Policy Memo 94
Date Issued: September 10, 1996
Policy File Ref: A810

ISSUE:

Determine if the Medicare Secondary Payer (MSP) rules increase skilled nursing facility benefits.

Background:

Under the Blue Cross component of the Empire Plan there is no coverage for skilled nursing facilities if an active or retired enrollee is Medicare primary. The question arose as to whether this practice conforms to newly clarified MSP rules.

Policy:

Empire Plan benefits must be the same for Medicare primary active enrollees and their Medicare primary dependents as for similarly situated NYSHIP-primary active employees.

This does not mean that the Empire Plan cannot coordinate such benefits as secondary to Medicare, nor does it affect the scope of benefits provided to retirees who are Medicare primary.