Department of Civil Service

NY96-27
PE96-12
PA96-06

TO: NY, PE, PA Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Medicare Crossover
DATE: June 7, 1996

Many employees are planning to retire, and they need to know about the new Medicare Crossover program. For new retirees, agency Health Benefits Administrators are the main source of information on this program.

Under the Medicare Crossover program, Empire Plan enrollees who are eligible for primary Medicare coverage can have Medicare file claims directly with MetraHealth. This direct filing eliminates paperwork, confusion and delays for the enrollee, but the enrollee must sign up for the program. There is no cost to the enrollee for tbis service and no change in benefits.

The enclosed information and enrollment form explain Medicare Crossover in detail. Please help your retiring Empire Plan enrollees leam about and sign up for the Medicare Crossover Program. Please copy the attached Medicare Crossover enrollment form as needed, and give it to any retiree who is nearing age 65, 65 years of age or older, and/or has a Medicare eligible dependent. Encourage Medicare eligible retirees to read the explanation of the program. They should complete the enrollment form as soon as possible and mail it to the address provided on the application.
Please stress that this program is available to them at no cost and will in no way change their benefits.

Thank you for your help with this project. If you have any questions on Medicare Crossover, please call MetraHealth Service Corp. directly at 1-800-942-4640.

NEW YORK STATE HEALTH INSURANCE PROGRAM
MEDICARE CROSSOVER ENROLLMENT FORM

FOR EMPIRE PLAN RETIREES AND DEPENDENTS WHO ARE MEDICARE PRIMARY
FOR EMPIRE PLAN GROUP #3050

Yes! I want to participate in the Medicare Crossover Program.

Enrollee: (Please complete even if employee or retiree is deceased) (PLEASE PRINT)

Name

Empire Plan ID#

Soc. Sec. #

Date of Birth

Address

Apt #

City

State

Zip*

Medicare Claim #

(Fill in all characters from your Medicare Health Insurance Card)

Dependent:

Name

Soc. Sec. #

Date of Birth

Medicare Claim #

(Fill in all characters from your Medicare Health Insurance Card)

If you live part-time in other states where you might incur medical expenses, please indicate these additional states below (maximum of two additional states):

Additional State 1:

Additional State 2:

Mail completed form to:

Medicare Crossover Program
MetraHealth Service Corp.
P.O. Box 1600
Kingston, New York 12402-1600

MEDICARE CROSSOVER PROGRAM

For Empire Plan Enrollees and Dependents

What is Medicare Crossover?

Medicare Crossover is the process by which Medicare, as primary insurance carrier, automatically forwards medical claims to a secondary carrier - in your case, MetraHealth Service Corp. - for processing. Under Medicare Crossover, the paperwork is eliminated for you. Medicare processes the claim first, then submits claims electronically to MetraHealth.

Who can use Medicare Crossover?

Medicare Crossover is available to all Medicare-primary Empire Plan enrollees and their Medicare-eligible dependents when the Empire Plan is the secondary payer.

When you retire and you become eligible for Medicare because of age, disability or end stage renal disease, health insurance benefits are paid in the following order:

Medicare pays first (primary)
Empire Plan pays second (secondary)

Note: If you are also covered while working for an employer other than New York State, or under your working spouse's employer plan, that plan pays first; Medicare, second; and the Empire Plan, third.

Will my benefits be different under this new method?

No. Medicare Crossover does not change the benefits of the Empire Plan. Only the paperwork has been eliminated for you.

Is there any cost to me for Medicare Crossover?

No. There is no charge to you as an Empire Plan enrollee for Medicare Crossover.

How will I know that Medicare has sent my claim to MetraHealth Service Corp.?

Your Explanation of Medicare Part B Benefits (EOMB) will tell you that your claim has been forwarded to your secondary carrier. (The EOMB may refer to your "secondary carrier" rather than to MetraHealth Service Corp. specifically.) If the message does not appear, you will have to submit the claim to MetraHealth Service Corp. yourself along with your EOMB. You may also call MetraHealth Service Corp. at 1-800-942-4640 if you have a question.

Will I ever need to submit my own claims?

You must submit claims to MetraHealth for services received outside the area served by the Medicare intermediary which processes claims for the area of your primary residence. If you reside in another area for part of the year, and/or expect to have medical expenses in yet another area, you may fill in the name of the additional state(s) on the Medicare Crossover enrollment form. By doing so, you will have automatic filing for those claims.

Where should I send the enrollment form?

When you have completed the enrollment form send it to:

Medicare Crossover Program
MetraHealth Service Corp.
P.O. Box 1600
Kingston, New York 12402-1600