An “active individual” is an employee, an employer (e.g., proprietor or partner), an individual associated
with the employer in a business relationship (e.g., suppliers and contractors who
do business with the employer and their employees) or a member of the family of any
of these persons such as the spouse, parent or child of such an individual. Medicare
is secondary payer under this provision for active individuals entitled to Medicare
based on disability who have coverage under an LGHP.
In some cases, the disabled individual may be the employee, employer, or individual
associated with the employer in a business relationship. In other cases, the disabled
person may be the “family member” of the employee, employer, or individual associated with the employer in a business
relationship. This means that a disabled person who is not an employee, as defined
in paragraph C.4., but who is covered under an LGHP of a spouse, parent, or any other
family member is considered to be an “active individual.”