Insurers are required by Mandatory Insurer Reporting to report Medicare beneficiaries that are covered through an employer's Group Health Plan (GHP) as the insured or as a member of the insured's family.

The statue allows for the Government to penalize those employers that do not cooperate with the Insurer's efforts to identify insured beneficiaries.

Sec. 1862 [42 U.S.C. 1395y(7)(5)

(C) Insurers Contacting employers.—

(i) In general.—With respect to each individual (in this subparagraph referred to as an “employee”) who was furnished a written statement under section 6051 of the Internal Revenue Code of 1986 by a qualified employer (as defined in section 6103(l)(12)(E)(iii), of such Code), as disclosed under subparagraph (B)(i) the appropriate fiscal intermediary or carrier shall contact the employer in order to determine during what period the employee or employee's spouse may be (or have been) covered under a group health plan of the employer and the nature of the coverage that is or was provided under the plan (including the name, address, and identifying number of the plan).

(ii) Employer response.—Within 30 days of the date of receipt of the inquiry, the employer shall notify the intermediary or carrier making the inquiry as to the determinations described in clause (i). An employer (other than a Federal or other governmental entity) who willfully or repeatedly fails to provide timely and accurate notice in accordance with the previous sentence shall be subject to a civil money penalty of not to exceed $1,000 for each individual with respect to which such an inquiry is made. The provision of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).

 

Insurers may be forced to deny coverage for employees without SSN

During a town meeting with the Centers for Medicare and Medicaid Services (CMS) this week, CMS told insurers they are required to provide a Social Security Number (SSN) or a Health Identification Claim Number (HICN) as part of the new Section 111, Mandatory Insurer Reporting requirements. This will apply to all employees over 45 years of age. Since a HICN is based on an SSN, employers will still have to ensure that employees have a SSN.

CMS's objective in requiring the SSN is so they can accurately identify a Medicare beneficiary working for an employer, but since MIR requires an employer's insurer to report every individual over 45 years of age, the impact will be broader. To make sure there are no errors in the insurer's report, CMS will compare the reported SSN, or HICN, the first six characters of the employee's first name and last name, birthday and sex to Social Security Administration (SSA) records If only 3 of 4 records match, CMS will correct the fourth using data from SSA.

CMS is requesting that insurers contact their insured employers to correct any errors. Unfortunately, an employer can not make the change on behalf of the employee. The employee will have to contact SSA to make the change.

CMS stated that for aliens that are seeking citizenship do not have to be reported until they have obtained an SSN. Then they are to be reported to CMS along with their original date of coverage.

Insurers are required to report employee's Social Security Numbers as part of their reporting requirements.  In order to do so, the insurer must have the cooperation of the employer to retrieve the information.  In the face of heavy penalities for failure to report, insurers may alter the insurance plan's contractual agreements, or, in the extreme, refuse to cover employers that do not cooperate.  The law allows for penalizing employers that do not cooperate with the collection of this information --  up to $1,000 per individual.   Employers will have to supply Medicare the information, but they need not share their employees' private information with their insurer and / or third party administrator.  They can use an independent agent, like Medicare Consul Services, to provide the information.