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Wednesday, June 15, 2011

Reimbursing NYSHIP Medicare-eligible retirees for Medicare Part B premiums

Reimbursing NYSHIP Medicare-eligible retirees for Medicare Part B premiums
Munger v Board of Educ. of the Garrison Union Free School Dist., 2011 NY Slip Op 05034, Appellate Division, Second Department

Carol Munger and other retirees of the Garrison Union Free School District sued in an effort to recover damages for breach of contract and for a judgment declaring that they are entitled to reimbursement for money they expended for Medicare Part B premiums since reaching the age of 65. Supreme Court dismissed Munger’s Article 78 petition.
Munger appealed and the Appellate Division reinstated that branch of her petition seeking reimbursement for Medicare Part B premium payments

Ruling that the issue of the school district's obligation to reimburse Munger and her co-plaintiffs for their Medicare part B premiums was not decided in the prior arbitration proceeding, the Appellate Division held that the arbitrator's award did not have preclusive effect on Munger's Article 78 action.

The court then explained that in considering a motion to dismiss a pleading for failure to state a cause of action, “the court must accept the allegations of the complaint as true, accord the plaintiff the benefit of every possible favorable inference, and determine only whether the facts as alleged fit within any cognizable legal theory.”

Noting that Munger had submitted documents relating to the school district’s obligation, “as members of the statewide health care consortium,” to reimburse their retired employees for Medicare Part B premiums paid by the retirees pursuant to Civil Service Law §167-a, the Appellate Division observed that Civil Service Law §167-a requires that employers participating in the New York State Health Program for State and Local Governments to reimburse retirees who are 65 years of age or older for Medicare premium charges.

According, said the court, Munger and her co-plaintiffs every possible favorable inference from their allegations and supporting documents, the Garrison Union Free School District’s motion to dismiss Munger's first cause of action alleging breach of the collective bargaining agreements and seeking declaratory relief should have been denied.

Randall Comments: The Munger case appears to be another example of a public employer participating in the New York State Health Insurance Program attempting to circumvent the mandates of Civil Service Law §167-a* A brief review of the genesis of §167-a may be illuminating.

Many years ago Thomas McCracken, the then director of the Department of Civil Service
s health insurance unit, concluded that the State could realize substantial financial benefits in terms of a reduction in the employers contributions to the New York State Health Insurance Program for State and Local Government [NYSHIP] if individuals and the dependents of such individuals that were Medicare eligible retirees had Medicare as their primary insurer.**

Mr. McCracken was instrumental in the drafting and adoption of Civil Service Law
§167-a to this end. He also successfully advocated modifying NYSHIP's health insurance contracts to exclude from NYSHIP coverage those benefits otherwise available to Medicare eligible retirees and their dependents under Medicare. The reason for this: Medicare premiums were less than the premium costs that would have been otherwise required were the State to continue to provide these benefits to retirees and their dependents were NYSHIP the primary insurer.

In developing the plan, Mr. McCracken realized that, in effect,
excluding such coverage for retirees in the NYSHIP contracts for health insurance mandated that the Medicare eligible retirees designate Medicare as their primary insurer or lose a significant portion of their health insurance coverage as the NYSHIP contracts would only provide Medicare-eligible retirees and their dependents with health insurance benefits otherwise available to active employee that were not covered by Medicare.

To maintain their same level of health insurance benefits, the Medicare eligible retiree would be required to pay the Medicare premium otherwise required for Medicare as well as the full “employee contribution” required for NYSHIP. Hence the amendment of the Civil Service Law to provide for the reimbursement of Medicare premiums to the Medicare eligible retirees set out in

As an illustration, if the employee contribution for individual coverage in NYSHIP was $xxx per year, the Medicare eligible retiree would be required to pay $xxx for his or her NYSHIP participation and, in addition, pay $yyy per year for Medicare premiums for a total of $zzz.Thus the Medicare eligible retiree would be eligible for the same level of health insurance benefits otherwise available to the non-Medicare eligible individual under NYSHIP but would be required to pay more in premiums for the identical coverage.

To eliminate this adverse financial impact on Medicare eligible retirees, §167-a was enacted in order to provide for the reimbursement of Medicare premiums to Medicare eligible retirees by the retiree’s employer, thus, once again, limiting their cost for health insurance to the $xxx per year that was required of active employees and non-Medicare eligibles in NYSHIP while NYSHIP continued to reap substantial financial savings to the benefit of the State and NYSHIPs participating employers.

Simply stated, but for the Medicare eligible retirees participating in Medicare as their primary health insurance carrier, the health insurance costs to the State, participating employers and NYSHIP enrollees, active and retired, for health insurance benefits through NYSHIP would be higher.

* Civil Service Law §167-a, in pertinent part, provides: Reimbursement for medicare premium charges. Upon exclusion from the coverage of the health benefit plan of supplementary medical insurance benefits for which an active or retired employee or a dependent covered by the health benefit plan is or would be eligible under the federal old-age, survivors and disability insurance program, an amount equal to the premium charge for such supplementary medical insurance benefits for such active or retired employee and his or her dependents, if any, shall be paid monthly or at other intervals to such active or retired employee from the health insurance fund.

In addition, 4 NYCRR 73.3(6) provides as follows: (6) The employer shall pay an additional sum each month equal to the current monthly Federal Medicare charge as the employer's share of the cost of coverage for each employee and dependent covered under the health insurance plan who is 65 years of age or older, while 4 NYCRR 73.1(b), Definitions, defines the term "employer" as follows: (b) The term employer or an employer shall include the State of New York (in all its departments and agencies and those departments and agencies of the State maintained and financed from special or administrative funds) and any participating employer. The term participating employer shall mean any public authority, public benefit corporation, school district, district corporation, municipal corporation or other public agency, subdivision or quasi-public organization which elects, with the approval of the President of the Civil Service Commission, to include its employees and/or retired employees in the plan.

** Eligible individuals are not required by federal law to participate in Medicare upon attaining age 65 but if the individual elects not to do so, he or she may be required to pay higher Medicare premiums should he or she later decide to enroll in Medicare.

The Munger decision is posted on the Internet at:


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