If you’re a currently employed participant who is nearing age 65 or if your spouse is nearing age 65, your employer’s authorized benefits representative must complete the Employer Certification – Medicare Secondary Payer (MSP) Rules form and send it to GuideStone. The form should be returned to GuideStone 30 days prior to your or your spouse’s 65th birthday.
Medicare Secondary Payer (MSP) rules determine how Medicare and GuideStone pay your medical benefits. Your employer's MSP status is based on how many employees are employed by your ministry organization. When completing the form, your benefits representative will need to indicate the current employee count. This may seem complicated, but it’s important to state the count accurately.
Your ministry has not had more than 19 employees on the payroll for any 20 or more calendar weeks in the current or preceding calendar year.
MSP status: Medicare will be the primary payer of medical claims.
Your ministry has 20 or more employees on the payroll for any 20 or more calendar weeks in the current or preceding calendar year.
MSP status: GuideStone will be the primary payer of medical claims.
If your ministry falls into the first category, 1-19 employees, it’s exempt from MSP rules. If your ministry falls into the second category, 20+ employees, it’s subject to MSP rules. The rules determine who pays your medical benefits first – Medicare or GuideStone. If a medical claim is paid incorrectly, Medicare will require reimbursement for overpayment of claims and a penalty may be additionally assessed.
Under the Medicare Secondary Payer rules, an employer with twenty or more employees is required to offer employees age 65 and over the same health coverage as is offered to employees under age 65. This equal benefit rule applies to coverage offered to all employees working 20 or more hours. The employer is also prohibited from offering financial incentives that encourage employees not to enroll or to terminate enrollment in a group health plan that is, or would be, primary to Medicare. This means that employers cannot offer Medicare-eligible employees benefits that are alternatives to the employer’s primary health plan unless the employee has other coverage that is primary to Medicare. It is a violation of the Medicare law every time a prohibited offer is made, regardless of whether it is oral or in writing. Any entity that violates the prohibition is subject to a civil money penalty of up to $5,000 per violation.
Looking for more information about Medicare and your health plan? Call 1-888-98-GUIDE (1-888-984-8433) and a health benefit specialist will be happy to assist you.
This information only highlights the depth of coverage and benefits you receive when you protect yourself with GuideStone. There are limitations and exclusions that apply.