Medicare Carve Out Participants

Prior to August 1, 2002, retiring employees were permitted to continue participating in the medical insurance plan, but subject to the "Maintenance of Benefits" provisions. After August 1, 2002, coverage terminated for retiring Employees who had reached Medicare Eligibility Age. Provision was made to continue coverage for those already insured under the "Maintenance of Benefits" provisions. The Plan includes prescription drug coverage.

To avoid duplication of benefits for a patient who has more than one health plan, most employers include a provision in their plan wording to minimize instances in which a person may profit from duplicate coverage. The method used by General Synod's Medical Plan is Maintenance of Benefits.

Under Maintenance of Benefits or Carve Out, the secondary plan (General Synod Plan) calculates the benefit that would be paid as though it were the primary plan, then subtracts the payment of the primary plan (Medicare Part A and Medicare Part B) and pays the balance, if any. No payment will be made if General Synod's benefit is equal to or less than Medicare's payment. If, however, the General Synod's payment would have been greater than the Medicare payment, the General Synod payment will be the difference between what it would have paid and the amount paid by Medicare.

Example 1 (After Deductible has been met, if applicable)

Office visit charge: $100
Medicare payment: $80
General Synod's normal benefit: $80
No payment will be made by the General Synod plan

Example 2: (After Deductible has been met, if applicable)

Office visit charge: $100
Medicare payment: $60
General Synod's normal benefit: $80
Secondary plan will pay $20

Links

General Information and Eligibility
Insurance Highlights (PDF)
Medicare Part D Creditable Coverage (PDF)
Retired Part D Creditable Coverage Certificate (PDF)
Healthcare Consumerism - How to Help Hold Down Costs
Benefit Plan Document (PDF)
Privacy Notice (PDF)
PHI Release (PDF)
Benefits