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.

eLearning course for Administrators:
Medicare Secondary Payer Small Employer Exception (MSP SEE)

Download  information about the SEE Plan:
Letter to Members
Medicare Secondary Payer SEE Member Fact Sheet
SEE Eligibility Certification Form