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September 16, 1988

Medicare as Secondary Payer-Reply

Author Affiliations

Health Care Financing Administration Baltimore

Health Care Financing Administration Baltimore

JAMA. 1988;260(11):1555. doi:10.1001/jama.1988.03410110063024

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In Reply.—  The law provides that Medicare is secondary payer to large group health plans for "active individuals." This term is defined in the law as "an employee (as may be defined in regulations), the employer, an individual associated with the employer in a business relationship, or a member of the family of any of those persons." Congress did not define the term employee nor indicate that it intended this term to apply only to actively working individuals. Also, by specifying that the term employee may be defined in regulations, Congress implicitly authorized the HCFA to define the term employee.Our instructions, published in April 1988, include persons actively working, as well as persons not actively working, within the definition of an employee. An individual who is not actively working is considered an employee if the individual's relationship to an employer is indicative of employee status. Whether such a person