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Employee Spouse Reaches Age 65

Employee's Spouse at age 65

Medicare Eligibility

A spouse reaching age 65 has the option of rejecting the Trust’s group coverage and carrying Medicare alone, or the spouse may choose to continue coverage under the employee’s group health plan and enroll in Medicare.

We will send the spouse a letter approximately 3 months prior to his or her 65th birthday. This letter explains that the Trust will assume that the spouse will maintain the Trust’s coverage and that the Trust will be the primary payor of benefits, with Medicare as secondary payor. The employee and spouse will remain in the standard family premium rate classification.

If the spouse wishes to reject coverage under the group health plan and have only Medicare coverage, he or she must notify us. If the spouse rejects group health coverage, the spouse’s coverage will end on the first day of the month in which the spouse reaches the age of 65. The employee’s health plan will be changed to a standard single premium rate classification. If dependent children are covered, however, the subscriber’s health plan will remain in a standard family premium rate classification.

If the spouse maintains group coverage, Medicare will become the primary payor of benefits for the spouse when the employee retires, and the Trust will be the secondary payor. We will change the subscriber’s health plan to the appropriate premium rate classification effective on the first day of the month following the date of retirement (last date worked). The spouse must apply for Medicare Parts A and B to retain full benefits.

Even if he or she does not apply, we will pay claims as if Medicare is the primary insurer and we are the secondary insurer.

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