R96-148 AUTHORIZING APPLICATIONS

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. 3. ESRD: The MSP statute also prohibits a GHP from taking into account that an individual is entitled to Medicare benefits as a result of ESRD during a coordination period specified in the stat- ute. This coordination period begins with the first month the individual becomes eligible for or entitled to Medicare based on ESRD and ends 18 months later. During this period, the GHP must pay primary for all covered health care items or services, while Medicare serves as the secondary payer. GHPS are prohibited from offering secondary(i.e., "carve-out") and "Medigap" coverage in this context. 4. Employer Obligations: It is the obligation of the Employer to ensure that Covered Persons covered by the MSP stat- ute are not improperly enrolled in "carve-out" or"Medigap" coverage under this Agreement. B. The New Information System ' Improved Information Gathering: In an effort to facilitate the processing of claims consistent with the requirements of the MSP stat- ute, and to assist in meeting the statutory obligations, certain BlueCross and BlueShield Plans together with the Health Care Financing Administration ("HCFA"), the federal government agency which administers Medicare, are developing or have developed a new enrollment and membership system. The system, also referred to as the "Data Match," is aimed at obtaining, in a timely and current fashion, information necessary for the Claim Administrator to identify dual coverage situations which fall within the MSP statute, and to determine whether primary or seo- ' ondary payment should be made for a particular claim. ', • Under the system,the Claim Administrator will provide basic information to HCFA about individu- I als enrolled in GHPs who are also covered by Medicare so that HCFA can better detect dual cov- erage situations. The Employer hereby authorizes and directs the Claim Administrator to disclose to HCFA periodi- cally, the information identified below pertaining to Medicare-eligible Covered Persons under the Plan.The Employer further agrees to cooperate,and to require and facilitate its employees coop- eration, in supplying to the Claim Administrator the following information. Information on Medicare-Eligible Covered Persons •Beneficiary Name •Date of Birth •Sex •Social Security Number •Health Insurance Claim Number (e.g., Medicare Number) •Relationship to Employee (e.g., Employee, spouse of Employee, child of Employee, other relationship to Employee) •Reason for Medicare Entitlement (e.g., age, disability or ESRD) Information on Employee •Employee Name � •Social Security Number •Individual Certificate Number of Employee - 10 -