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$1000.00 deductible requirement for govornmental self insured medcia


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My situation is after i was injured on a govornmental

job, and forced out on disability my spouse aquired

medicare to supplement our self insured plan medical

coverage to limit our out of pocket medical expenses.

I pay for self insured benefits out of my disability

check, and my spouse pays for the medicare. My self

insured plan took the position that the medicare would

be primary, and that until we pay $1000.00 out of our

pocket after what medicare pays then the self insured

plan won't pay anything. We could go an entire year

and not accumulate enough bills to pay $1000.00 out of

our pockets, yet i am paying for coverage that i may

never get benefits from. Can someone shed some light

on this. It makes no sense to me.

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Regardless of the "position" that you say the plan has taken, the real question is what does your SPD and the Plan Document say? I would also seek some input on Medicare as primary from Medicare and the supplement provider (NOT the sales agent)on the issue of primacy because I got the impression that the Medicare coverage might not be on both of you but only on one.

George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

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