HI 00208.085 Role of the Railroad Retirement Board
RRB has responsibility for claims for payment for covered services involving all “qualified railroad retirement beneficiaries” (see HI 00801.011), except for those services furnished by Group Practice Prepayment Plans (see HI 00208.095) whose membership is not limited to railroad employees or annuitants or their families and for services by plans which deal directly with CMS.
A. The responsibilities of RRB
RRB enrolls qualified railroad retirement beneficiaries for medical insurance; makes determinations as to the eligibility of such individuals for enrollment; and makes determinations as to the beginning and ending of any coverage period resulting from such enrollment.
2. Collection of premiums
RRB collects medical insurance premiums by deduction from annuities (or by remittance when deductions are not possible). However, RRB does not collect premiums from beneficiaries whose premiums are paid by a State.
3. Issuance of health insurance cards
RRB issues health insurance cards to qualified railroad retirement beneficiaries for whom it has jurisdiction.
B. Contracts between RRB and carriers
1. Functions to be performed by carriers
As provided by law, RRB selects and enters into contracts with Part B carrier(s) in the same manner as CMS. RRB has selected Travelers Insurance as its nationwide representative to process medical insurance claims involving enrollees who are railroad retirement beneficiaries.
NOTE: The claim of any qualified RR beneficiary is processed by the Travelers Insurance Company even though he is also entitled to RSDI benefits.
2. Comparability of payments
RRB is required to take action to assure that payments by its carrier conform to the payments made in the same locality for comparable services by the area carrier acting for CMS. This is intended to keep to a minimum disparities in reasonable charge determinations for services by the same physicians and suppliers. Complaints alleging disparity in payments should be called to the attention of the Medicare Bureau RO.
C. General provisions of the RRB-CMS agreements
1. Utilization records
Beneficiary utilization records (of deductibles met and payments made under Part B) are maintained by CMS.
2. Exchange of information
Information is exchanged by CMS and RRB to the full extent necessary for efficient and effective administration.
CMS reimburses the RRB and the carrier for Medicare administrative costs.
4. Modification and termination of agreement
The operating agreement between CMS and RRB may be modified or terminated by either upon reasonable notice which takes into consideration the rights and the needs of beneficiaries. Termination is subject to appropriate notice to the carrier(s) involved.
5. Availability of CMS services
RRB may use CMS facilities and staff when it is more efficient and economical to do so. This is done at the times and under the conditions upon which CMS and RRB agree.