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Special Circumstances That Affect COB
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
They are not actively employed but:
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
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
Working Status
Kidney Transplant
Regained Function
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