COB Playbook

Special Circumstances That Affect COB

Working Status

 Defined as a person who’s actively employed, not actively employed but is paying FICA (less than 6 months), retains employment rights and not yet terminated  Medicare considers the policyholder to be working when:

They are actively employed

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They are not actively employed but:

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 Less than 6 months into disability leave (still paying FICA)

 Retains employment rights, not yet terminated by the employer not yet considered a COBRA (example: consultant work)  If on disability for longer than 6 months, regardless of work status, Medicare will become primary

Kidney Transplant

 If a patient returns to dialysis within 36 months of having a kidney transplant, their COB will continue uninterrupted  If a patient has a kidney transplant that lasts for more than 36 months, a new COB period may apply, if other conditions are met  No new waiting period would apply if patient returns to dialysis  Kidney transplant prior to RCDB / FDODE – when patients have kidney failure and are able to receive a transplant prior to their first dialysis treatment, the date of transplant will be considered their FDODE. This is important for COB should the kidney fail and patient needs dialysis

Regained Function

 If a patient regains their kidney function and is able to discontinue dialysis, but must return to dialysis prior to 12 months, their COB will continue uninterrupted  If the patient’s kidney function is regained for more than 12 months ,and they later return to dialysis, a new COB period may apply.  No new waiting period would apply