United States 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Benefits Administration Letter 

Number: 09-206 Date: November 3, 2009 

Subject: Federal Employees Health Benefits Program: New Medicare 

Requirements for Coordination of Benefits 

Purpose 

The purpose of this letter is to require Federal agencies to follow new reporting requirements 

established by the Centers for Medicare and Medicaid Services (CMS) regarding the 

collection of identification numbers for individuals covered by health insurance who may 

also be entitled to Medicare benefits. 

Background

Section 111 of Public Law 110-173, the Medicare, Medicaid, and SCHIP Extension Act of 

2007, includes new reporting requirements under the Medicare Secondary Payer law. CMS 

has issued instructions to employers and health plans with its requirements to ensure that 

Medicare can properly coordinate Medicare payments with other insurance. Health plans are 

required to disclose information about other insurance coverage for Medicare beneficiaries 

who are still working. Health plans are also required to disclose information on insurance 

coverage for spouses and dependents if they are Medicare beneficiaries. 

CMS prefers obtaining the beneficiary’s Medicare claim number, known as the Health 

Insurance Claim Number (HICN), but will use the beneficiary’s social security number 

(SSN) if the HICN is not available. The CMS requirements, which became effective 

January 1, 2009, include substantial penalties for non-compliance if the beneficiary 

information is not provided by January 2011. 

Agencies should obtain HICNs for enrollees and family members covered under the Federal 

Employees Health Benefits (FEHB) Program who are Medicare beneficiaries. Agencies 

should also continue to collect SSNs for enrollees and begin to collect SSNs for all family 

members when processing new enrollments and enrollment changes using Standard Form 

2809 or using express-enrollment systems, such as Employee Express and PostalEASE. 
Procedures 

Agencies should notify employees that health plans will need HICNs and/or SSNs for the 

following individuals to process new enrollments and enrollment changes: 

• Health plan enrollees who are 65 years of age or older and who have coverage based 

upon their own or a spouse’s current employment status. 

• Health plan enrollees who have been receiving kidney dialysis or who have received a 

kidney transplant, regardless of their own or a family member’s current employment 

status. 

• Health plan enrollees who are under age 55 (age 45 effective January 1, 2011), have 

coverage in the plan based on their own or a family member’s current employment status, 

and are known to be entitled to Medicare. 

• From January 1, 2009 through December 31, 2010, health plan enrollees who are age 55 

through age 64 and who have coverage based on their own or a family member’s current 

employment status. 

• Beginning January 1, 2011 and forward, health plan enrollees who are age 45 through 64 

who have coverage based on their own or a family member’s current employment status. 

Agencies should ensure enrollees have included the HICNs and/or SSNs for themselves and 

family members on enrollment forms before forwarding them to health plans. Part A of the 

Health Benefits Election Form (SF 2809) already has fields for SSNs. Agencies should 

ensure enrollees include the appropriate HICN for any Medicare covered individual in the 

remarks section of the SF 2809. Agencies should also advise employees to cooperate with 

their health plans if contacted for this information. For those employees who do not have 

access to e-mail, agencies should notify employees by mail. 

Express-enrollment systems should be updated to include a request for all family members’ 

SSNs and to ensure that the SSN fields for these systems are completed by the enrollee 

before the enrollment change can be processed. The system should also notify enrollees that 

they need to provide HICNs to their health plan, if requested. 

Agencies are not required to establish and maintain collection systems for family members’ 

SSNs and/or HICNs. This information is for CMS and health plan use only. Agencies will 

not be required to include this data in employee enrollment reconciliation procedures. The 

health plans are responsible for collecting SSNs and/or HICNs for their current members. 

To notify employees about this new requirement, we suggest you use the following 

information: 

A new mandatory insurer reporting law (Section 111 of Public Law 110-173) requires 

your health plan to report, as directed by the Secretary of the Department of Health 

and Human Services, information that the Secretary requires for purposes of 

coordination of benefits between your health plan and Medicare. In order for 

Medicare to properly coordinate Medicare payments with other insurance and/or 

workers’ compensation benefits, Medicare relies on your health plan to collect the 

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Medicare Health Insurance Claim Number (HICN) or social security number (SSN) 

from you and your family members and provide them to Medicare. 

As a Federal Employees Health Benefits (FEHB) Program health plan enrollee (or 

spouse or family member of an enrollee), if this information is not already on file 

with your health plan, Medicare HICNs and SSNs will likely be requested in order to 

meet the requirements of Public Law 110-173. Attached is a sample notice from 

CMS which employers and health plans will use to collect the necessary information 

from health plan enrollees. Please cooperate with your health plan if you receive a 

request for this information. If you or your family member is a Medicare beneficiary 

and you do not provide the requested information, you or your family member may 

be violating obligations to assist Medicare in coordinating benefits. 

In accordance with the Privacy Act, OPM publishes a routine-use notice in the 

Federal Register that provides for disclosure to contracting health insurance carriers 

information that is necessary for them to identify insured persons, verify eligibility 

for payment of a claim for health benefits, or to carry out coordination of benefits 

with other health plans. Although FEHB carriers are not subject to the Privacy Act, 

their contracts with OPM limit their use of personal information that agencies and 

enrollees supply, including SSNs, to purposes consistent with the routine-use notice. 

In addition, each FEHB plan’s benefit brochure includes a statement for enrollees that 

their medical and claims records are confidential. 

As in the past, an individual who objects to the use of an SSN as an identifier may decline to 

provide it. In these instances, the agency and the carrier use a unique number for 

identification purposes. However, this may cause potential delays in claims processing. 

Agencies should request an individual who objects to the use of an SSN to provide the 

HICN, if one has been issued for the individual or family member, in the remarks section of 

the SF 2809 Health Benefits Registration Form, and should inform the individual that if the 

individual or a family member is a Medicare beneficiary and does not provide the SSN or 

HICN, he or she may be violating obligations to assist Medicare in coordinating benefits. 

The agency should document the reason stated by the individual for declining to provide the 

SSN. 

If you have any questions, please contact Nataya Battle, Senior Policy Analyst, Strategic 

Human Resources Policy, at 202.606.0004. Thank you for your continued support of the 

FEHB Program. 

Sincerely, 

Kathleen M. McGettigan 

Deputy Associate Director 

 Center for Retirement and Insurance Services 

Attachment 

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