Which Coverage Is Primary

You must tell us if you or a covered family member has the Original Medicare or Medicare Part D or a Medicare Advantage coverage. To ensure we record the Medicare coverage correctly in your enrollment file, we ask that you send us a copy of your Medicare identification card.

You must also let us obtain information about services denied or paid under Medicare if we ask about this information. Normally, this information is necessary to determine how to provide benefits under your Service Benefit Plan coverage.

In Most Cases Medicare Is Primary

If you are only enrolled in Medicare Part B, Medicare is primary regardless of your employment status.

It's helpful to remember that (except for ESRD patients) Service Benefit Plan coverage is usually primary (pays first), and the Original Medicare pays second for all who are actively employed by the federal government who also have Medicare Part A or Parts A and B. This category includes:

• annuitants (retirees) who are re-employed by the federal government and their covered spouses,

• survivor annuitants who work for the government, and

• federally employed spouses of annuitants.

If you or a covered family member is eligible for Medicare because of end-stage renal disease (ESRD), the Service Benefit Plan is the primary payer during the first 30 months of ESRD treatment after the patient becomes entitled to Medicare coverage except if Medicare was the patient's primary payer before the patient became eligible for Medicare due to ESRD. Then, if you enroll or continue your enrollment in Medicare after the 30 month period, Medicare becomes the primary payer.

When your Service Benefit Plan coverage pays your health care expenses first, your benefits are the same as those of any other federal employee who is working, and your Medicare and Service Benefit Plan deductibles, copayments and coinsurances are not waived.

Determining which coverage is primary can be confusing. Take a look at the following chart to help figure out what coverage is primary for you.

You must also tell us about other coverage you or a covered family member may have in addition to Medicare and the Service Benefit Plan. This additional coverage may impact the primary and secondary status of either or both Medicare and the Service Benefit Plan.

Coordination Of Benefits

Coordination of benefits between Medicare* and the Service Benefit Plan to determine who pays first.

A. When You Or Your Covered Spouse Are Age 65 Or Over And Have Medicare And You…		Then The Primary Payer Is…
1. have FEHB coverage on your own as an active employee or through your spouse who is also an active employee 2. have FEHB coverage on your own as an annuitant or through your spouse who is an annuitant 3. Are a reemployed annuitant with the Federal government and your position is excluded from the FEHB and you are not covered under the FEHB through your spouse under #1 above 4. Are a reemployed annuitant with the Federal government and your position is not excluded from the FEHB and… • You have FEHB coverage on your own or through your spouse who is also an active employee • You have FEHB coverage through your spouse who is an annuitant 5. Are a Federal judge who retired under title 28, USC or a Tax Court judge who retired under Section 7447 of title 26, USC, or if your covered spouse is this type of judge and you are not covered under the FEHB through your spouse under #1 above 6. Are enrolled in Medicare Part B only, regardless of your employment status 7. Are a former Federal employee receiving Workers' Compensation and the Office of Workers' Compensation has determined that you are unable to return to duty		Service Benefit Plan Medicare Medicare Service Benefit Plan Medicare Medicare Medicare for Part B services. Service Benefit Plan for other services Medicare*
B. When You Or A Covered Family Member…		Then The Primary Payer Is…
1. Have Medicare solely based on end stage renal disease (ESRD) and… • It is within the first 30 months of eligibility for or entitlement to Medicare due to ESRD (30-month coordination period) • It is beyond the 30-month coordination period and you or a family member are still entitled to Medicare due to ESRD 2. Become eligible for Medicare due to ESRD while already a Medicare beneficiary and… • The Service Benefit Plan was the primary payer before eligibility due to ESRD • Medicare was the primary payer before eligibility due to ESRD		Service Benefit Plan Medicare Service Benefit Plan for the 30-month coordination period Medicare
C. When Either You Or A Covered Family Member Are Eligible For Medicare Solely Due To Disability And You…		Then The Primary Payer Is…
1. Have FEHB coverage on your own as an active employee or through a family member who is also an active employee 2. Have FEHB coverage on your own as an annuitant or through a family member who is also an annuitant		Service Benefit Plan Medicare
D. When You Are Covered Under The FEHB Spouse Equity Provision As A Former Spouse…		Then The Primary Payer Is Medicare

* Workers' Compensation is primary for claims related to your condition under Workers' Compensation.

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