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Medicare Secondary Payor Rules

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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?

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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!

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