Medicare Plus (Plan J or HJA)
- Participating Physician Groups (PPG)
(does not apply to HSP)
If the member has conversion or Medicare Plus (Plan J or HJA) coverage:
- Medicare is primary
- The plan is always secondary
Medicare Plus (Plan J or HJA) is non-group coverage for Medicare beneficiaries who have lost eligibility through group or conversion plans.
Medicare Plus is available to subscribers and their spouses when:
- They are age 65 or older.
- Their previous group or conversion coverage has ended.
- They are covered by both Parts A and B of Medicare (current employment does not affect eligibility for Medicare Plus).
- They are not enrolled in another HMO plan through a Medicare HMO contract.
When the plan discovers that a Plan J or HJA member is not covered through both Parts A and B of Medicare or that the member is enrolled in another HMO plan through a Medicare HMO contract, the plan cancels the member's Plan J or HJA coverage.
Application for Medicare Plus must be made within 31 days of the member's last date of group or conversion coverage.