MEDICARE

Persons For Whom Medicare Is Secondary

1. Subscribers who work for employers of 20 or more employees, and who, or whose spouses, qualify for Medicare due to reaching age 65.

• Federal law applicable to employers of 20 or more employees requires that their Medicare-eligible employees age 65 and over decide (for both self and Medicare-eligible spouse) either (a) to continue the employer-sponsored group health benefits coverage or (b) to select Medicare as primary coverage.

NOTE: When the employee is under 65 and the spouse is age 65 or over, this decision must be made for the spouse alone.

• If the employee decides to continue the employer-sponsored group health coverage, then Kaiser Permanente coverage is provided on the same basis as for group members under 65. Such Kaiser Permanente coverage would be "primary" meaning that Kaiser Permanente pays for covered services before Medicare does, and that Medicare benefits are secondary to any benefits to which the member is entitled as a Kaiser Permanente member. If the employee selects Medicare as primary, the employee and spouse cease to be covered by the employer-sponsored health benefits coverage, including Kaiser Permanente.

Therefore, references to Medicare in this booklet do not apply to any such member who selects Kaiser Permanente coverage to be primary over Medicare.

2. Subscribers who work for employers of 100 or more employees and who, or whose dependents, qualify for Medicare due to disability.

• Federal law applicable to employers of 100 or more employees requires that the employer-sponsored group health benefits coverage be primary over Medicare for employees or their dependents who qualify for Medicare due to disability. This means that Kaiser Permanente pays for covered services before Medicare does, and that Medicare benefits are secondary to any benefits to which the member is entitled as a Kaiser Permanente member.

Therefore, references to Medicare in this booklet do not apply to any such disabled member for whom Kaiser Permanente is primary over Medicare.

Persons For Whom Medicare Is Primary. The monthly charge for Kaiser Permanente coverage is based on the assumption that Kaiser Permanente will receive payment from Medicare for services provided to members entitled to Medicare benefits. Persons entitled to Medicare benefits must submit to Kaiser Pemanente all consents, releases, authorizations, and other documents necessary for Kaiser Permanente to obtain Medicare reimbursement. Any member who fails to do so must pay for services at Non-Member Rates, or at Kaiser Permanente's discretion, a surcharge will be applied to his or her membership charges.

References to Medicare in this booklet apply to the following categories of members for whom Medicare is primary over Kaiser Permanente:

1. Members who were enrolled in Medicare prior to December, 1985 and who have not enrolled in Kaiser Permanente Senior Advantage coverage.

2. Subscribers who work for employers of 19 or fewer employees and who, or whose spouses, qualify for Medicare due to reaching age 65.

3. Subscribers who work for employers of 99 or fewer employees and who, or whose dependents, qualify for Medicare because of disability.

Persons Eligible for Medicare Who Continue to Work. If you are over age 65, currently enrolled in Part B of Medicare and continue to work, you may choose to receive Medicare-covered services and benefits through Kaiser Permanente at no additional charge to you or your employer. To qualify, you must work for an employer with 20 or more employees, maintain enrollment in Part B of Medicare and enroll in Kaiser Permanente's Senior Advantage program. You can receive all of your regular Kaiser Permanente group benefits, plus additional Medicare-covered services and benefits. For more information, please contact our Medicare Services Department at (303) 338-3800.

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NAVIGATION

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Introduction | Benefit Changes | How to Use | Definitions | How Your Plan Works | Who Is Eligible | When Coverage Starts | Benefits And Services | Referrals and Restrictions on Choice of Providers | Emergency Services | Urgent Care | Health Plan's Appeals Procedure | Special Claims Procedures for Medicare Members | General Provisions | Binding Arbitration | Coordination Of currentbenefits | Medicare | What Is Not Covered | When Coverage Stops | Continuation Of Coverage | Customer Satisfaction Procedure | Service Information | Statement Of Financial Condition | Important Phone Numbers | Local Designated Hospitals | Supplemental Benefits | Benefit Chart

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Website for Kaiser of Colorado

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Denver Public Schools
Employee Benefits Department
900 Grant Street, Room 502
Denver, Colorado 80203
(303) 764-3371