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Policy/Memo 98

Number: Policy Memo 98
Date Issued: January 29, 1997
Policy File Ref: A810

ISSUE:

Determine Medicare Secondary Payer (MSP) status of domestic partners of active NYSHIP enrollees.

Background:

Our carriers informed us that Medicare should be the primary insurer for Medicare eligible domestic partners of active NYSHIP enrollees; this is contrary to what is done for spouses. A review of the current MSP regulations indicated that there is an apparent discrepancy in the way domestic partners are to be treated under MSP rules, depending upon whether their Medicare eligibility is based upon age or disability. We wrote to HCFA for clarification. This policy is based on the response they provided.

Policy:

The Medicare eligible domestic partner of a NYSHIP enrollee with health insurance as an active employee is to be treated in the following manner for benefit coordination with Medicare:

  1. If the domestic partner is Medicare eligible due to age, Medicare is primary and the enrollee should receive a Medicare credit for the domestic partner.
  2. If the domestic partner is Medicare eligible due to disability, NYSHIP is primary.

Medicare is primary insurer for all Medicare eligible domestic partners of NYSHIP retirees.