Coordination of benefits with Medicare in group health plans

THE STATE OF NEW HAMPSHIRE INSURANCE DEPARTMENT 21 SouTH FRUIT STREET SUITE 14 CONCORD, NEW HAMPSHIRE 03301 Christopher R. Nicolopoulos Commissioner David J. Bettencourt Deputy Commissioner Bulletin Docket No: INS 21-028-AB To: All Health Carriers From: Conunissioner Christopher R. Nicolopoulos, Esq. ~ . \,~ Date: May 7, 2021 Re: Coordination of Benefits with Medicare in Group Health Plans The purpose of this bulletin is to provide additional guidance to health carriers regarding coordination of benefits ("COB") with Medicare in group health plans. All group health plans in New Hampshire must comply with the New Hampshire Administrative Rule Part Ins 1904 Group Coordination of Benefits. Ins 1904.04(d)(3) prohibits the use of a COB provision to reduce the benefits all6wed when "[a] person is or could have been covered under another plan, except with respect to Part B of Medicare (emphasis added)." The rule only exempts Medicare Part Band does not exempt Medicare Part A. The Department understands that the New Hampshire Benchmark Plan includes language regarding COB with Medicare. The Department interprets the Benchmark Plan, when read in conjunction with Ins 1904.04(d), to allow the insurer to reduce benefits in group health plans with respect to Medicare Part B only. A group health plan may only coordinate benefits with Medicare when Medicare is or would be the primary payer in accordance with federal rules. Given that there are many factors to consider in each COB situation, health carriers should ensure that their applitation of COB provisions complies with New Hampshire law. All future product submissions for group health plans containing a COB provision must ensure that the policy language clearty states COB only occurs with Medicare Part B. T ELEPHONE 603 -271-2261 • FAX 603-271-1406 • TDD ACCESS RELAY NH 1-800-735-2964 WEBSITE: www.nh.gov/insurance