[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR408.82]



[Page 283-284]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 408_PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE--Table of Contents

 

               Subpart E_Direct Remittance: Group Payment

 

Sec. 408.82  Conditions for group billing.



    CMS agrees to a group billing arrangement only if the following 

conditions are met:

    (a) Conditions the group payer must meet. The group payer submits a 

written request for group billing--

    (1) Showing that all or part of the payments are made from the 

payer's funds or from funds due the enrollees and in the payer's 

possession; and

    (2) Agreeing not to charge the enrollees for the service of paying 

the premiums or for the administrative costs such as recordkeeping and 

postage.

    (b) Enrollees eligible for group payment. (1) Group payment may be 

made only on behalf of individuals who are already enrolled and are 

being billed for direct remittance.

    (2) Group payment may not be made for enrollees whose premiums are 

being deducted from monthly benefits in accordance with Subpart C of 

this part or being paid by the State under a buy-in agreement.

    (c) Protection of enrollee's rights. The use of group billing must 

not jeopardize the enrollees' right--

    (1) To confidentiality of personal information;

    (2) To terminate enrollment;

    (3) To resume individual payment of premiums if he or she wishes; 

and

    (4) To receive notice of any action that affects the SMI benefits.

    (d) Authorization by the enrollee. (1) To ensure maximum feasible 

protection of the rights specified in paragraph (c) of this section, 

each enrollee must give written authorization as specified in Sec. 

408.84(a)(2).

    (2) A group payer that is not an entity of State or local government 

must submit all enrollee authorizations to CMS.

    (3) A group payer that is an entity of State or local government may 

retain the authorizations and certify to CMS that it has on file an 

authorization for each enrollee included in the group.

    (4) It is on the basis of the enrollee's authorization that CMS 

sends the group payer information about each enrollee, as necessary to 

carry out the group payment function.

    (e) Size of group. The number of enrollees must be at least 20, 

which is the minimum size sufficient to make group



[[Page 284]]



billing efficient. (Smaller groups may use the informal procedure 

described in Sec. 408.80(b).)