Medicare_Carriers_Manual / 3329 / 3329.6_Nondiscrimination.--

Why This Topic Matters

The article helps readers understand how Medicare coordination rules affect employer-sponsored coverage and how nonconformance may be identified, documented, and communicated. It supports compliance review for plans that interact with Medicare beneficiaries and related secondary payer obligations.

Article Sections

1. A. Prohibitions Against Taking Into Account Medicare Entitlement When Medicare Is Secondary

   Overview of situations in which group health plans and large group health plans must not treat Medicare entitlement as a factor in coverage administration. The section addresses broad categories of beneficiaries protected under Medicare secondary payer policy.

2. B. Equal Benefits for Older and Younger Employees and Spouses

   Discussion of nondiscrimination requirements related to benefits provided to older and younger employees and spouses. The section focuses on parity concepts within employer-sponsored coverage.

3. C. Nondifferentiation for ESRD

   General guidance on prohibited differentiation involving individuals with ESRD. The section outlines the scope of the ESRD-related nondiscrimination rule.

4. D. Examples of Actions That Constitute Taking Into Account

   Examples of plan actions that may be treated as impermissible consideration of Medicare entitlement. The section describes broad categories of conduct involving coverage administration, billing, and communications.

5. E. Permissible Distinctions

   Discussion of plan distinctions that may be allowed when they are based on factors unrelated to Medicare entitlement. The section also addresses certain coordination-of-benefits situations and continuation coverage context.

6. F. Determination of Nonconformance

   Explanation of how HCFA may determine that a plan is nonconforming and the types of failures that can lead to that finding. The section also notes consequences related to mistaken primary payments and information failures.

7. G. Documentation of Conformance

   Guidance on documentation that a plan may need to provide to show compliance with MSP-related requirements. The section includes general expectations for supporting materials and plan explanations.

8. H. Referral of Nonconforming Plan Cases To Regional Office

   Procedural guidance for referring suspected nonconforming plan cases to the Regional Office. The section emphasizes reporting and explanation of the referral basis.

9. I. Starting Dates for Determination of Nonconformance

   Lists the dates from which HCFA’s authority to determine nonconformance begins for different categories of MSP-related issues. The section is an administrative timing reference.

10. J. Notice of Determination of Nonconformance

    Describes notice procedures when HCFA determines that a plan is nonconforming, including notices to the plan and to contributing employers or employee organizations. The section also addresses hearing-related timing and required notice content.