103.089. Medicare benefits participants, effect. - Missouri Statutes

Medicare benefits participants, effect.

103.089. Participants in the program of medical benefits coverageprovided by sections 103.003 to 103.175 who are eligible for Medicare benefitsand who are not eligible for the program of medical benefits coverage providedunder sections 103.083 to 103.098 to be their primary plan of coveragebenefits shall be provided the same benefits provided participants who are noteligible for Medicare benefits. Medical benefits coverage provided undersections 103.003 to 103.175 shall be coordinated with Medicare benefits forparticipants covered by part A or part B, or both, of Medicare benefits, orreduced by an amount determined by the claims administrator to provide abenefit equivalent to the amount which would be provided on a coordination ofbenefit basis for participants not covered by part A or part B, or both, ofMedicare benefits. As used in sections 103.083 to 103.098, the term "Medicarebenefits" shall include those medical benefits provided by Title XVIII, A andB, Public Law 89-97, 1965 amendments to the federal Social Security Act (42U.S.C. section 301, et seq.) and amendments thereto. Any participating memberagency having employees or eligible retirees not covered by Medicare shallauthorize the plan at its option to enroll those individuals for medicalbenefits as provided by Title XVIII, A and B, Public Law 89-97, 1965amendments to the federal Social Security Act whenever they become eligiblefor such benefits and the plan shall pay the premium for such enrollment onbehalf of that person. The Medicare premium amounts shall be included in therate established by the actuary for providing medical benefits coverage tosuch a participating member agency. Anyone not authorizing this Medicareenrollment shall be denied coverage.

(L. 1992 H.B. 1574 § 2 subsec. 3)