MACs are responsible for determining changes in primary payment status (i.e., whether Medicare is the primary payer). Employers who wish to have the payment status changed for disabled beneficiaries must submit certain beneficiary data to the MACs. Employers must also advise the MACs of the date the LGHP will no longer pay primary benefits. The LGHP's primary payer responsibility may not terminate earlier than 8/10/93.

Disabled beneficiaries who do not have LGHP coverage based on current employment status will have the payment status changed to reflect Medicare as the primary payer. (Medicare becomes the primary payer the month following the last month the LGHP pays primary benefits.)

The MAC will provide the employer with a letter certifying that Medicare is now the primary payer and the effective date Medicare becomes the primary payer. A list of the employer's disabled beneficiaries for whom Medicare is now the primary payer will be attached to the letter.

The employer will give each disabled beneficiary a notice that includes the following information:

• •

  the date Medicare becomes the primary payer,

• •

  the opportunity for immediate enrollment in SMI, and

• •

  all months the beneficiary was covered under the LGHP.

The beneficiary will also be given a copy of the MAC letter that certifies that Medicare is the primary payer. (The list of beneficiary names will not be given to the disabled individual.)

The employer will advise the beneficiary to take the employer letter and the MAC certification to Social Security if they wish to enroll in SMI.

Lamont Stevens is on long-term disability from the General Motors Corporation. Lamont has been entitled to disability benefits since 11/90 and became eligible for Medicare effective 11/92. Lamont refused SMI since the was covered under an LGHP. In 4/99, the employer notified Lamont that the LGHP is no longer primary payer of benefits beginning 5/1/99 and advised Lamont to contact SSA about enrolling in SMI under the D-SEP provisions. The notice stated that Lamont has been covered by the LGHP since 11/90 and a copy of the MAC certification was provided.

Lamont's D-SEP is 5/99 through 11/99. Lamont enrolled in SMI in 8/99 and requested an effective date of 9/99. There is no premium surcharge because Lamont has been covered under the LGHP since the first time of eligibility for SMI and the only months the LGHP was not primary were 5/99 through 8/99.

Lynne Robbins, who began working for the Monsanto Company in 3/93, has been on long-term disability since 9/95. Lynne became eligible for Medicare effective 2/98 but refused SMI because the was covered under an LGHP.

In 12/99, Monsanto informed Lynne that they became secondary payer of benefits effective 6/1/99 and advised Lynne to contact SSA about enrolling in SMI under the D-SEP provisions. The notice stated that Lynn had been covered by the LGHP since 3/93. The employer also provided a copy of the MAC certification.

Lynne's D-SEP is 12/99 through 6/00. Lynne enrolled in SMI in 1/00 and requested an entitlement date of 6/99. Lynne also signed an installment agreement to have the past due premiums deducted from the social security disability benefit check at the rate of $20 monthly. There is no premium surcharge since Lynne has been covered under the LGHP since first becoming eligible for SMI.

Jackie Johnson, employed at University Hospital since 11/89, has been covered under the Hospital's LGHP since Jackie began working. Jackie has not actually worked since 6/96. Jackie was entitled to disability benefits effective 1/95 and was automatically enrolled in SMI beginning 1/97. Jackie requested termination of the coverage effective 9/97.

In 1/00, the employer informed Jackie that they are no longer primary payer of benefits beginning 1/99 and advised to contact SSA about enrolling in SMI under the D-SEP provisions. The letter stated that Jackie has been covered under the LGHP since 11/89 and a copy of the MAC certification is also provided.

Jackie's D-SEP is 1/00 through 7/00. Jackie enroll in SMI in February and requests an effective date of 3/00. A 10 percent premium surcharge applies since the months the employer is not primary payer of benefits (1/99 – 2/00) can not be excluded from the surcharge calculation. Should Jackie have requested an retroactive effective date of 1/99, Jackie would not have incurred a premium surcharge.