Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
TEFRA The 1982 Tax Equity and Fiscal Responsibility Act (TEFRA)
applies to employers with 20 or more employees. Under TEFRA,
group health coverage becomes the primary payer and Medicare
the secondary payer for active employees between ages 65 and 70.
TEFRA applies to active employees from the first day of the
month of their 65th birthday to the first day of the month following
their 70th birthday.
DEFRA Effective January 1, 1985, the Deficit Reduction Act (DEFRA)
expands the TEFRA aged workers guidelines to include dependent
spouses (ages 65 to 70) of actively employed workers under 70.
COBRA On April 7, 1986, the Consolidated Omnibus Budget
Reconciliation Act (COBRA) amended the Working Aged
Provision to eliminate the age 69 limit. Medicare will no longer
become primary payer when an employed person turns age 70 or
the spouse of an employed person turns 70. The group remains
primary payer until the employee retires.
OBRA The Omnibus Budget Reconciliation Act (OBRA) of 1986
introduces the term ‘‘active individual’’ and defines it as the
employee, the employer, or individual associated with the
employer in a business or family relationship. Medicare will now
be the secondary payer for disabled Medicare beneficiaries who
elect to be covered by an employer-based group health plan, either
as current employees or family of such employees. The minimum
number of employees under this provision is set at 100. The
employer’s insurance pays primary.
8-42 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)