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  4. Local Government Health Plan

LGHP and Medicare 

 

Local Government Health Plan Medicare Requirements

Each plan participant must contact the SSA and apply for Medicare benefits upon turning the age of 65. If the SSA determines that a plan participant is eligible for Medicare Part A at a premium-free rate, the plan participant must accept the Medicare Part A coverage.

If the SSA determines that a plan participant is not eligible for premium-free Medicare Part A based on his/her own work history or the work history of a spouse at least 62 years of age (when applicable), the plan participant must request a written statement of the Medicare ineligibility from the SSA. Upon receipt, the written statement must be forwarded to the Medicare Coordination of Benefits (MCOB) Unit to avoid a financial penalty. Plan participants who are ineligible for premium-free Medicare Part A benefits, as determined by the SSA, are not required to enroll into Medicare Parts A or B.

Employees with Current Employment Status (and their applicable Dependents)

Members who are actively working and become eligible for Medicare (or have a dependent that becomes eligible for Medicare) due to turning age 65 or due to a disability (under the age of 65) must accept the premium-free Medicare Part A coverage, but may delay the purchase of Medicare Part B coverage. The Local Government Health Plan will remain the primary insurance for plan participants eligible for Medicare due to age or disability until the date the member retires or loses Current Employment Status (such as no longer working due to a disability-related leave of absence). Upon such an event, Medicare Part B is required by the Local Government Health Plan.

Retirees and Employees without Current Employment Status (and their applicable Dependents)

Members who are retired or who have lost Current Employment Status (such as no longer working due to a disability related leave of absence) and are eligible for Medicare (or have a dependent that becomes eligible for Medicare) due to turning age 65 or due to a disability (under the age of 65) must enroll in the Medicare Program. Medicare is the primary payer for health insurance claims over the Local Government Health Plan. Failure to enroll and maintain enrollment in Medicare Parts A and B when Medicare is the primary insurance payer will result in a reduction of benefits under the Local Government Health Plan and will result in additional out-of-pocket expenditures for health-related claims.

Plan Participants Eligible for Medicare on the Basis of End Stage Renal Disease (ESRD):

Plan participants who are eligible for Medicare benefits based on End Stage Renal Disease (ESRD) must contact the State of Illinois CMS Medicare COB Unit for information regarding Medicare requirements and to ensure proper calculation of the 30-month Coordination of Benefit Period.

Each plan participant who becomes eligible for Medicare is required to submit a copy of his or her Medicare card to the CMS Medicare COB Unit at 801 S. 7th Street, P.O. Box 19208, Springfield, IL 62794-9208.  Cards may also be faxed to the Medicare COB Unit at (217) 557-3973.