Jump to content

Medicare Secondary Payor Rules


Recommended Posts

We consider our LTD recipients (whether or not receiving SSDI benefits) to be active employees with respect to health, dental and vision benefits. As such, we expect our health plans (self insured) to be primary and Medicare secondary. Recently one TPA stated that these employees don't qualify as "current" employees according to the Medicare Seconday Payor guidelines. Can we not consider them active employees on a leave of absence status?

Link to comment
Share on other sites

Guest Benefits Broker CO

I would think it might depend also on how eligibility is defined. I once had a group medical client that covered employees out on long-term medical leave, and these individuals had to be defined in the Plan Document as eligible (regardless of COBRA) or the reinsurer would not cover their claims. Medicare is always looking for a reason to pay secondary!

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
 Share

×
×
  • Create New...