ANTHEM BLUE CROSS AND BLUE SHIELD (BCBS) PLANS
KAISER PERMEMENTE PLANS
* Also available as Medicare Secondary Payer (MSP)
HSA Fact Sheets for Administrators
Health Plan Options for Active Employees Age 65+
For employees who continue to work in the Episcopal Church on or after reaching age 65 or those who return to work after retirement, determining health plan eligibility and options may require several considerations.
Refer to the Bulletin for Group Benefit Administrators: Understanding Health Plan Options for Employees Age 65+ for details.
Medicare Secondary Payer Small Employer Exception Plan
The Medical Trust offers the option for eligible employers to offer the Medicare Secondary Payer (MSP) Small Employer Exception (SEE) Plan for eligible employees.
The Medical Trust provides the option for eligible employers to apply for the Medicare Secondary Payer (MSP) Small Employer Exception (SEE). If an employer applies for and is approved for the plan, eligible employees and their spouses can choose to participate in the SEE Plan.
In most cases, Medicare is the secondary payer of healthcare claims for active employees covered under Medicare Part A, and the Medical Trust plan is the first, or primary, payer. Medicare allows for an exception to the secondary payer rule for small employers called the Small Employer Exception (SEE). Participation in SEE is voluntary for eligible employers and their employees. It is anticipated that out-of-pocket costs will be lower for plan participants and that employers will save significantly in the cost of health benefits.
All participating employers in the SEE Plan are required to recertify annually. If you do not recertify annually, your participation will be terminated. To recertify:
- Complete Part II of the SEE Eligibility Certification Form
- Send it to your group administrator
- Your group administrator will process the recertification and return it to Client Services (See the instructions on page 2 of the form.)
These plans are noted with MSP in the plan name.
Qualifying for SEE
In order to be eligible to participate, employees and/or spouses must be:
- 65 years or older
- Enrolled in Medicare Part A
- Enrolled in a Medical Trust SEE plan
- Work for an employer with fewer than 20 employees
What costs are covered?
Under the exception, Medicare will become the primary payer of claims covered under Medicare Part A. These include hospitalization expenses, including inpatient care in hospitals, skilled nursing facilities, hospices and home healthcare settings. The MT plan will be the secondary payer. For other coverage, such as doctor visits, outpatient procedures and prescription drug coverage, the Medical Trust plan will be the primary payer. However, if an employee or eligible spouse elects to enroll in Medicare Part B coverage, Medicare will become the primary payer of Part B claims and the MT plan will be the secondary payer.
Download information about the SEE Plan:
You can ask for a paper copy of your Summary of Benefits and Coverage (SBC) at any time, free of charge. Go to Forms and Publications. Check the box next to the Summary you want and then click on Mail It to Me. You can also call Client Services at (800) 480-9967 Monday - Friday 8:30AM to 8:00PM ET (excluding holidays) to request a copy.
The Medical Trust can also provide an SBC in a Spanish, Chinese, Tagalog, and Navaho. Please see our Notice of Nondiscrimination policy page or call Client Services for more information.
Health benefits are offered through plans maintained by Church Pension Group Services Corporation (doing business as The Episcopal Church Medical Trust), 19 East 34th Street, New York, NY 10016.
Unless otherwise noted, websites referenced herein that are outside the www.cpg.org domain are not associated with The Church Pension Fund and its affiliates (collectively, the Church Pension Group) and the Church Pension Group is not responsible for the content of any such websites.