Medicare Secondary Payor

Topic:

Coordination of large employer health benefits with Medicare.

Source:

Sec. 1862, Social Security Act; 42 U.S.C.A. 1395y.

Features:

Requires employers with 20 or more employees to provide primary coverage for certain otherwise eligible Medicare beneficiaries (e.g., workers aged 65 to 69 and those with end-stage renal disease). Individuals and government may enforce this by lawsuit and obtain double damages.

Effect:

Subordinates Medicare payment to employers' plans and reduces outlays by Medicare.

Comment:

Subject of current nationwide recoupment effort; topic of past investigations. 135

The Civil Rights Act

Topic:

Discrimination in employment practices.

Source:

Civil Rights Act of 1964, Title VII; 42 U.S.C.A. 2000e-2.

Features:

Employment practices include health benefits. Protected classes for race, color, sex, religion, and national origin.

Effect:

Bans discrimination in health benefits based on a suspect classification.

Comment:

Few cases have been reported based on race discrimination; more cases arise under the Pregnancy Discrimination Act of 1978, an amendment. 136

The Age Discrimination in Employment Act

Topic:

Discrimination in employment practices.

Source:

29 U.S.C.A. 621 et seq.

Features:

Employment practices include health benefits. Protects workers who are at least 40 years of age. Age-based distinctions are allowed pursuant to a "bona fide" benefits plan, provided that the distinctions are not a "subterfuge."

Effect:

Provides equal access to health benefits for older workers.

Comment:

Older Workers Benefit Protection Act137 codified the "equal benefits/equal cost" rule from EEOC regulations,138 which allows employers to either provide the same amount of benefits or to spend an equal amount to provide reduced coverage to older workers

The Americans with Disabilities Act

Topic:

Discrimination in employment practices.

Source:

42 U.S.C.A. 12101.



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