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A. WHAT IS MEDICARE
Medicare is a federal program of health insurance. Part A, the basic
hospital insurance plan, pays for most
hospital, home health, hospice, and skilled
nursing facility services. Part B is an
optional supplementary medical insurance
plan that pays a percentage of your doctors'
bills, medical equipment, and certain
outpatient services.
Under most circumstances, You are eligible for Medicare at age 65
if You have retired, or if still employed
at age 65, upon retirement. Persons with
certain severe health conditions, such
as end stage renal disease, may be eligible
for Medicare prior to turning 65.
B. COORDINATION WITH MEDICARE, PART A
If you are
a Retiree enrolled in Medicare Part A,
Community First will pay whatever you
are responsible for (minus any copayments)
after Medicare pays. If, for whatever
reason, you are a Retiree not enrolled
in Medicare Part A, Community First will
be the primary payer.
C. COORDINATION WITH MEDICARE, PART B |
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| 1. |
Employees Who Retired
And Were Medicare Eligible Prior
To September 1, 1992.
Community First will provide benefits secondary to Medicare Part B, if the Retiree is enrolled in Medicare Part B. As secondary Payor, Community First must pay the difference between the Medicare allowed amount and the Medicare paid amount, less the appropriate copayment, if the provider accepts Medicare assignment. If the provider does not accept Medicare assignment, Community First must pay the difference between the Medicare maximum allowable and the Medicare paid amount, less the appropriate copayment.
If the Retiree is not enrolled in Medicare Part B, Community First will pay primary benefits. Community First will not require Part B coverage as a condition of enrollment for those Retirees.
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| 2. |
Employees Who Retired And Became Medicare
Eligible On Or After September 1,
1992.
Community First will provide benefits secondary to Medicare Part
B, as described in Section 1, above, whether or not the Retiree is
enrolled in Medicare Part B. Thus, if You are eligible for Medicare
Part B and choose not to enroll, you likely will be responsible for
significantly more out-of-pocket costs. Community First shall
provide only secondary benefits for any member eligible for
Medicare coverage as a result of end-stage renal disease whether
or not the member elects Medicare Part B coverage. |
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| 3. |
Retirees under age 65 receving Social Security Disabitlity
Community First shall pay benefits as if the retirees under age 65
who receive Social Security disability benefits purchased Medicare
Part B. Community First shall provide only secondary benefits as if
Part B coverage is in force, even if Part B is not purchased by the
eligible participant. Community First will not require member to
purchase Medicare Part B coverage in those instances where
members are eligible for Medicare Part B, Community First shall
pay benefits on a secondary basis as though the eligilble member
enrolled in Medicare Part B. |
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| 4. |
Coordination of Benefits
Any individual who has Medicare as the primary coverage will not
have greater out-of-pocket expense than an individual who does
not have Medicare as the primary coverage, with the exception of
those who became Medicare eligible since September 1, 1992, in
which case Community First will pay secondary benefits even if the
member is not enrolled in Medicare Part B.
Part A: Community First will pay all of the Medicare Part A
deductible, less any applicable copayment.
Part B: Community First will pay the difference between the
Medicare allowed amount and the Medicare paid amount, less the
appropriate copayment, if the provider accepts Medicare
assignment. |
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