[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR422.106]

[Page 850]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 422--MEDICARE+CHOICE PROGRAM--Table of Contents
 
             Subpart C--Benefits and Beneficiary Protections
 
Sec. 422.106  Coordination of benefits with employer group health plans and Medicaid.

    (a) General rule. If an M+C organization contracts with an employer 
group health plan (EGHP) that covers enrollees in an M+C plan, or 
contracts with a State Medicaid agency to provide Medicaid benefits to 
individuals who are eligible for both Medicare and Medicaid, and who are 
enrolled in an M+C plan, the enrollees must be provided the same 
benefits as all other enrollees in the M+C plan, with the EGHP or 
Medicaid benefits supplementing the M+C plan benefits. Jurisdiction 
regulating benefits under these circumstances is as follows:
    (1) All requirements of this part that apply to the M+C program 
apply to the M+C plan coverage provided to enrollees eligible for 
benefits under an EGHP or Medicaid contract.
    (2) Employer benefits that complement an M+C plan, and the marketing 
materials associated with the benefits, are not subject to review or 
approval by CMS. M+C plan benefits provided to members of the EGHP, and 
the associated marketing materials, are subject to CMS review and 
approval.
    (3) Medicaid benefits are not reviewed under this part, but are 
subject to appropriate CMS review under the Medicaid program. M+C plan 
benefits provided to individuals entitled to Medicaid benefits provided 
by the M+C organization under a contract with the State Medicaid agency 
are subject to M+C rules and requirements.
    (b) Examples. Employer/Medicaid benefits, permissible EGHP or 
Medicaid plan benefits include the following:
    (1) Payment of a portion or all of the M+C basic and supplemental 
premiums.
    (2) Payment of a portion or all of other cost-sharing amounts 
approved for the M+C plan.
    (3) Other employer-sponsored benefits that may require additional 
premium and cost-sharing, or other benefits provided by the organization 
under a contract with the State Medicaid agency.

[65 FR 40320, June 29, 2000]