[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: 42CFR408.86]



[Page 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. 408.86  Responsibilities under group billing arrangement.



    (a) Enrollee responsibilities. (1) The enrollee is still responsible 

for premium payments; the group payer simply acts as his agent. If the 

agent fails to pay, or identifies the payment incorrectly, SSA notifies 

both the agent and the enrollee that the enrollee's account is 

delinquent. If an enrollee fails to take action on that notice, 

entitlement is terminated for nonpayment of premiums.

    (2) The enrollee must promptly notify both SSA and the group payer 

of any change of address.

    (b) Group payer's responsibilities. The group payer must--

    (1) Make premium payments promptly upon receipt of notices;

    (2) Promptly notify both CMS and the enrollee when it drops an 

enrollee from the group;

    (3) Make payments in a way that facilitates efficient and economical 

processing; and

    (4) Maintain the confidentiality of the personal information 

obtained from CMS for the group payment process.

    (c) CMS responsibilities. CMS--

    (1) Sends the bill to the group payer upon authorization from the 

enrollee;

    (2) Notifies both the payer and the enrollee if the payer fails to 

make timely payments; and

    (3) Refunds excess premiums in accordance with Sec. 408.88.