FEHB Program Carrier Letter
All Carriers

U.S. Office of Personnel Management
Office of Insurance Programs
Letter No. 2001-06 Date: March 20, 2001
     Fee-for-service [ 05 ]   Experience-rated HMO [ 05 ]   Community Rated [ 06 ]

SUBJECT: 2001 Medicare Match

If you have a current Medicare match agreement form on file, we will send your 2001 Medicare match results as early as next week.

Background

The Office of Personnel Management (OPM) and the Social Security Administration (SSA) recently matched payment records. The "Medicare match" is done through an OPM-SSA agreement whereby SSA matches our payment rolls each year to identify Medicare beneficiaries who are also on our annuity rolls. (Our Office of Retirement Programs maintains the records of most Federal retirees -- those who retired under the Civil Service Retirement System (CSRS) and Federal Employees Retirement System (FERS), their spouses if entitled to receive survivor benefits, and survivor annuitants.)

Please note that your match data report:

  • Will include names of people who SSA's records show have Medicare Part A, Part B, both A and B, and neither A nor B.

  • May include names that did not match. A "no match" generally means the retiree worked only under CSRS so SSA has no information in their records.

  • May include duplicate names. This happens when a person appears on our annuity rolls as both an annuitant and as a spouse.

  • Will not include Medicare effective dates. We agreed with SSA that we will not provide Medicare effective dates.

Your contract requires you to coordinate benefits with Medicare. Your benefits coordination staff should use this match data as leads to determine primary/secondary Medicare status. However, we cannot guarantee the data is accurate. Do not use it to update any file, take any claim or records action, or use it in any other way than to identify which annuitants might have Medicare. Verify Medicare coverage as you normally would, for instance, by surveying your members.

If you are a community-rated carrier please note: When your actuarial staff uses this data to help you to compute your Medicare rate loading, do not count individuals with match codes X, Z or N if they are under age 65. Further, since new retirees and people who recently turned age 65 may not be listed -- and the data is not fool-proof -- continue to survey your members for the most current and accurate Medicare data for your rate loading.

Data release agreement

Before we can send the data, you must agree to the terms of the OPM-SSA agreement to protect the privacy of individuals whose personal records are included in the match and to safeguard the data files on which the records are stored. Please note that our auditors may inspect your safeguards for protecting the match data.

If we do not have a current agreement on file, you must submit an agreement (Enclosure A) to your OPM contract specialist within 10 days.

Use the following to determine whether you need to submit the agreement:

  1. If your FEHB contract began on January 1, 2001, submit the agreement.

  2. If your FEHB contract began before that but you have had a major reorganization, merger, or sale of assets since you submitted the last form, submit the agreement.

  3. If (1) and (2) do not apply, take no action; do not send another agreement.

For more information about this letter, please contact Agnes Kalland (202/606-0745 or amkallan@opm.gov).

 

Sincerely,
Abby Block signature
Abby L. Block
Assistant Director
   for Insurance Programs
  

Attachment

Download Letter and Attachment as PDF File: Adobe Acrobat PDF File
Download Attachment Only as PDF File: Adobe Acrobat PDF File

2001 Carrier Letters   |    2000 Carrier Letters   |    1999 Carrier Letters
FEHB Home Page   |    OPM Home Page

 

Page created 20 March 2001