This section provides an explanation of supplemental insurance, complementary crossover, and Medigap policies. Additionally, we have listed the complementary crossover plans in our contract areas to which a beneficiary can subscribe. Please be sure to refer to this section whenever a beneficiary indicates that they have a Complementary Crossover plan.
Employer supplemental coverage is a supplemental health insurance plan offered by the beneficiary's or beneficiary's spouse's former employer to supplement Medicare coverage.
Because of the stringent requirements of Medigap coverage, some employer supplemental coverage plans participate as complementary crossover plans, while others do not. In order to be reimbursed for coinsurance by an employer supplemental plan that does not participate as a complementary crossover, the beneficiary or the provider must submit charges on their own to the employer supplemental plan.
Listed on the following pages are 54 supplemental insurance companies that participate in the automatic transfer of Medicare claim information with HGSAdministrators. This process is known as complementary crossover. Complementary crossover is a method of transferring Medicare claim information to insurance companies that offer policies which supplement Medicare coverage. As contrasted to a Medigap claims transfer where Medicare claim information of only participating providers is transferred, complementary crossover provides for the automatic transfer of Medicare claim data to insurers from both nonparticipating providers as well as from participating providers.
To participate in complementary crossover, each of the 54 supplemental insurers have entered into a written agreement with HGSAdministrators for the automatic transfer of Medicare claim information. Each insurance company is required to provide us with an eligibility file of their Medicare eligible beneficiaries who have supplemental insurance policies with them. The eligibility file is the only method of ensuring that a claim will be transferred to the supplemental insurer. If the beneficiary does not appear on the eligibility file, no claim information will be transferred to the supplemental insurer.
When a match occurs between Medicare claim information and the insurer's eligibility file, the Medicare claim information will be forwarded to that insurer. While some of the supplemental insurers listed have nationwide coverage, our transfer of claim information is limited to the beneficiaries listed on the eligibility file. Please note, additions or deletions of beneficiaries to the eligibility file are controlled by the supplemental insurer. Inquiries concerning the beneficiary's status on the eligibility file should be directed to the supplemental insurer.
a. Complementary Crossover Plans
The following companies have signed contracts for supplemental crossover with HGSAdministrators. Coverage is extended to all Medicare eligible beneficiaries based on eligibility files we receive from the Coordination of Benefits (COB) Insurer. Therefore, it is not necessary to report any information about the COB Insurer on the Medicare claim.
|Aetna Life and Casualty|
|American Family Life Assurance Company (AFLAC)|
|American Postal Workers Union (APWU)|
|AARP/United Health Care|
|Benefit Planners Inc.|
|BC/BS of Alabama|
|BC/BS of Delaware (BC/BS DEL)|
|Blue Cross and Blue Shield of Minnesota|
|BC/BS of New Jersey (BC/BS NJ)|
|BC/BS of Oklahoma .|
|BC/BS of Virginia - Trigon|
|BC/BS of United Wisconsin .|
|CareFirst BC/BS (MD)|
|CareFirst BC/BS (Metro DC)|
|Central States Health and Life.|
|Claims Administration Corp|
|Continental Life Insurance Company|
|Empire Blue Cross and Blue Shield|
|Fairfax County Teachers|
|Government Employees Hospital Association|
|Group Health Insurance|
|Harvest Life/Federal Home|
|Health Data Management Corp (HDMC)|
|Intercounty Hospital Plan|
|Kirke-Van Orsdel Inc.|
|MAMSI - OPCI|
|Metrahealth/United Health Care|
|Monumental Life Insurance Company|
|Mutual of Omaha|
|National Association of Letter Carriers|
|New Jersey Medicaid|
|Olympic Health Management Systems, Inc.|
|PA Employee Benefits Trust|
|Pennsylvania Blue Shield|
|Peoples Benefit Life Insurance Co.|
|Physicians Mutual Insurance Co.|
|Pioneer Life Insurance Company|
|Prudential Insurance Company|
|Special Agents Mutual Benefits Assoc.|
|Stirling and Stirling|
|United American Insurance|
|United Commercial Travelers|
|United Teachers Association (Fortis, Inc.)|
|Union Bankers Insurance|
|WorldNet Services Corporation|
The term Medigap refers to Medicare supplemental insurance. It is private health insurance designed specifically to supplement Medicare benefits by filling in some of the gaps in Medicare coverage. Examples of some of the gaps in Medicare coverage are:
The definition of a Medigap policy under Federal law does not include all insurance products that may help Medicare beneficiaries cover out-of-pocket costs. For example, a health plan offered by a company for current or former employees or by a labor organization for current or former members does not qualify as a Medigap insurance policy.
Medigap coverage varies depending upon the terms of the Medigap policy. Some Medigap policies provide coverage for Medicare's deductibles and most pay the hospital and medical coinsurance amounts. Federal law requires that, as a minimum, a Medigap policy sold as of July 30, 1992, must provide basic "core" benefits available in Plan A. There are 9 other standardized Medigap benefit Plans B through J contain the core "group of benefits" plus different combinations of additional benefits. The core benefits include:
providers, when the Medigap information is provided, Medicare will automatically
advise the Medigap insurer of Medicare's approved amount and payment for the
billed services. The Medigap insurer can then determine their liability and make
payment to the participating provider. This "one-step" billing
eliminates the need for you to submit a separate bill to the beneficiary or
their Medigap insurer after receiving Medicare's payment. For additional
information for placement of Medigap information on a HCFA 1500 (12-90) claim
form, please refer to Chapter 9. Reporting requirements for Medigap
information are as follows.
Claims Paper Claims Item ANSI ASC X12 ANSI ASC X12 NSF Versions HCFA Record DAO Block
3B.000 and 30.51.
1500 Claim Form
03 Data Element
03 Data Element
09 Data Element
09 Data Element
ANSI ASC X12
ANSI ASC X12
Claims Express Reporting
The Medigap/Insurer ID code is reported on the insurance table, please follow the below steps to select a Medigap insurer that already exists on the insurance file, or to add a new Medigap insurance company.
1. From main menu
screen, click on file maintenance icon.
2. Click on insurance folder.
3. Click on the ellipse (three dots) beside the INS code field. This will give you a list of insurances.
4. To select an insurance, highlight your selection by clicking on your choice, then click the “OK” check box.
5. Click on save before closing screen.
1. From main screen,
click in file maintenance icon.
2. Click on insurance folder.
3. Click on add box (this will clear your screen and enable you to add the new insurance).
4. Complete entire screen fields from the top to bottom.
5. Click on the down
arrow and highlight Medigap for the insurance type block.
6. Click on save before closing screen .
developed a listing to ease the reporting of Medigap address information. The
listing is an alphabetical list of insurers that offer Medigap policies. Each
Medigap insurer has been assigned a new
Medigap/Insurer ID code (previously called
co-codes). Participating physicians or suppliers are required to utilize the listing in the following section to obtain the Medigap/Insurer ID code.
Note: HGSAdministrators cannot crossover claim information to the appropriate supplemental insurer without the appropriate insurer ID code. Claims that contain the name and address of the medigap company but not the new insurer ID code, will not be sent to the secondary insurer. The use of the new insurer ID code, along with the Medigap group policy number and insured's or authorized person's's signature, will allow the claim to be sent to the secondary insurer.
a. Medigap/Insurer ID Listing