Policy/Memo 110

Number: Policy Memo 110
Date Issued: May 10, 1999
Policy File Ref: A830
Subject: Medicare Reimbursement

ISSUE:

Determine whether the current practice of withholding the Medicare credits of Medicare primary enrollees' dependents until receipt of the dependent's Medicare card should be replaced by automatic granting of the Medicare credit when the dependent reaches age 65.

Background:

Pursuant to Sec. 167-a of the CSL, upon the exclusion of Medicare's payment from the amount NYSHIP is required to pay for claims, the enrollee is granted a reimbursement of Medicare premium. Enrollees eligible for primary Medicare coverage such as retirees, vestees, certain COBRA enrollees and their dependents are required to join Medicare. Retirees are automatically granted a Medicare reimbursement upon reaching their 65th birthdays, the current Medicare eligibility date. It is NYSHIP policy to request the Medicare card of a retiree's dependent before granting the enrollee a Medicare credit for the dependent.

The practice of requesting a copy of dependent Medicare cards goes back to the old enrollment systems that did not even capture the spouse's social security number upon enrollment. NYBEAS makes it possible to grant Medicare credits beginning with the dependent's 65th birthday as noted on the files, which would be easier for administration. It would also provide a better legal position when the carriers carve out the amount Medicare would have paid from the Empire Plan obligation of those who did not join Medicare when eligible because they would receive a warning letter three months before the 65th birthday that they must join Medicare and will receive the credit.

Policy:

When a dependent of an enrollee who is eligible for Medicare primary payments becomes age 65, grant the Medicare credit automatically for that dependent as is done for enrollees. All enrollees and their dependents eligible for Medicare primary coverage will receive a letter at least three months before their 65th birthdays advising them of the need to join Medicare, that they will be receiving Medicare reimbursement, and instructing them to contact EBD if they are not eligible for Medicare or are already receiving a Medicare reimbursement from another source. Under 65 enrollees and dependents who become Medicare eligible will still have to submit a copy of the Medicare card since that may be the only way we learn of their eligibility.