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A Primer for Employers on Medicare Coordination of Benefits
March 24, 2023
When a plan participant or beneficiary has Medicare and other health insurance, such as group health plan insurance, retiree coverage or Medicaid, there can often be confusion as to which insurance pays first on claims. Coordination of Benefits (COB) rules, which are specified in plan documents or insurance policies, decide which insurance pays first. One plan is considered the primary payer that covers most expenses, while the secondary plan covers any remaining allowable expenses not covered by the primary plan. The COB allows health plans to provide health or prescription drug coverage to individuals receiving Medicare to determine their payment responsibilities. This helps ensure that the total amount paid by all insurance plans does not exceed the total costs of the health care expenses for Medicare-covered services and items.
This article provides a general overview of COB rules under Medicare.
How Does Medicare Work With Other Insurance?
There are many important facts to remember regarding how other insurance works with Medicare-covered services and items, such as the following:
- The primary payer pays first and up to its coverage limits.
- The secondary payer only pays if there are costs the primary payer doesn’t cover.
- The secondary payer, which may be Medicare in certain situations, might not pay all the uncovered costs from the primary payer.
- If a group health plan or retiree coverage is the secondary payer, the individual may need to enroll in Medicare Part B before that insurance would pay.
If a Medicare-covered individual’s other health insurance is the primary payer and fails to promptly pay a claim, typically within 120 days, that individual’s doctor or service provider may bill Medicare. Medicare can make a conditional payment for the individual’s claim, recovering any payments the primary payer should have paid at a later date.
What’s a Conditional Payment?
A conditional payment is a payment Medicare makes for services for which another payer may be responsible. Medicare makes this payment, so the plan participant or beneficiary won’t have to pay the claim. The payment is conditional because it must be repaid to Medicare if the Medicare-covered individual receives a settlement, judgment, award or other payment later.
Who Pays First?
When an individual has Medicare and other insurance, there are rules for whether Medicare or the other insurance is the primary payer for Medicare-covered services and items.
Medicare is typically the primary payer for Medicare-covered services and items in the following circumstances:
- An individual is covered by only Medicare and Medicaid.
- An individual covered by Medicare refuses group health coverage.
- Medical services or supplies are not covered under a group health plan but are covered under Medicare.
- A Medicare-covered individual is covered by a group health plan but has exhausted their coverage under the group health plan.
- A Medicare-covered individual is 65 or older and covered by a group health plan (because the individual or their spouse is still working) offered by an employer with fewer than 20 employees.
- A Medicare-covered individual is 65 or older and covered by an employer group health plan after retirement.
- A Medicare-covered individual is 65 or older (or disabled) and covered by Medicare and the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.
- A Medicare-covered individual is disabled and covered by a large group health plan offered by an employer with fewer than 100 employees.
- A Medicare-covered individual has end-stage renal disease and is enrolled in a group health plan or COBRA (after 30 months of eligibility or entitlement to Medicare).
- A Medicare-covered individual has only Medicare and TRICARE coverage unless the individual is on active duty and receives services and items from a military hospital, clinic or other federal health care provider.
For a complete list of situations where Medicare is the primary payer, visit Medicare.gov or review the Centers for Medicare and Medicaid Services’ guide, Medicare & Other Health Benefits: Your Guide to Who Pays First.
How Does Medicare Know if an Individual Has Other Coverage?
COB permits an individual’s Medicare eligibility information to be shared with other payers and sends Medicare-paid claims to secondary payers for payment. The Benefits Coordination and Recovery Center (BCRC) does the following on Medicare’s behalf:
- Collect and manage information on other types of coverage an individual with Medicare may have.
- Determine whether an individual’s other coverage pays before or after Medicare.
- Pursue repayment when Medicare makes a conditional payment.
Medicare doesn’t automatically know if a Medicare-covered individual has other health insurance; however, insurers are required to notify Medicare when they’re responsible for paying first for Medicare-covered services and items. In some instances, the individual’s health care provider, employer or insurer may ask them about their current coverage so they can report that information to Medicare. Additionally, insurers must report coverage changes to Medicare.
Summary
Understanding COB rules is vital to ensuring that a Medicare-covered individual’s claims are paid correctly. While COB rules can be complex, they can help Medicare plan participants and beneficiaries make the best use of their health care coverage.
For more health care resources, contact SimcoHR today.
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The future of work is changing fast, and HR leaders are taking notice. More than half of companies are planning to switch their HCM platform this year—but not just for any solution. They’re looking for intelligent, scalable, and AI-driven technology that doesn’t just process payroll but actively enhances business operations. The days of rigid, outdated systems are over. Now, businesses need platforms that adapt, automate, and evolve alongside them. At Simco, we’re passionate about delivering the most advanced, transformative solutions to our clients. That’s why we’ve partnered with isolved, a recognized leader in the HCM space, to provide our clients with a powerful, AI-enabled platform that makes workforce management effortless. With a focus on automation, predictive analytics, and employee experience, isolved is changing the game for small and mid-sized businesses—and we’re here to help you make the most of it. Why isolved Stands Out in the HCM Market For the second consecutive year, Nucleus Research has named isolved a leader in its HCM Value Matrix for Small and Medium-Sized Businesses (SMBs). The firm’s analysis highlights isolved’s enterprise-grade functionality, designed specifically for SMBs looking to streamline operations, enhance compliance, and leverage AI to drive efficiency. isolved’s adaptability ensures it evolves alongside customer needs. Whether an organization’s HR function matures or its priorities shift, isolved is uniquely positioned to support its success through continuous innovation. In 2024, the company launched 480+ product enhancements directly driven by direct customer feedback. Nucleus Research’s report also highlights several key updates, including: isolved's Candidate Match Tool , an AI-powered feature that evaluates and ranks candidates, streamlining the hiring process. Enhanced Talent Acquisition Services , including recruitment process outsourcing (RPO), job placement assistance, and comprehensive hiring solutions for quick-service restaurants (QSRs). A Broadened Content Library, now with over 95,000 courses designed for employee training, compliance, and professional development. A Next-Gen Time Clock , featuring advanced facial recognition and remote access for secure and accurate time tracking. The Power of Partnership: Simco + isolved While technology is the foundation, the real value comes from how it’s applied. At Simco, we don’t just provide software—we offer a full-service HCM and advisory solution, ensuring that all aspects of workforce management integrate seamlessly. Our clients benefit from: A Dedicated Client Success Manager – Your go-to resource who oversees your relationship with Simco, ensuring that every service—HCM, HR advisory, benefits, insurance, and retirement—works together without gaps. A Fully Integrated HCM & Advisory Solution – No need to juggle multiple vendors for payroll, HR advisory, employee benefits, commercial insurance, and 401(k)/retirement plans. Simco is your one-stop shop for all workforce solutions. Strategic Guidance & Ongoing Optimization – We help businesses maximize their investment in HCM technology while aligning it with compliance, employee engagement, and long-term growth goals. As businesses evolve, so do their workforce management needs. By combining isolved’s leading-edge technology with Simco’s hands-on service and industry expertise, we help businesses stay ahead of change, improve efficiency, and create better employee experiences. Ready to explore the future of HCM? Contact us today to learn more about how we can transform your workforce operations!
Cybercriminals continue to evolve their tactics, making phishing attacks more sophisticated and harder to detect. Every day, countless phishing emails reach inboxes, often with the intent to steal sensitive information or spread malware. Unfortunately, many of these attacks succeed in just a matter of seconds— the median time for users to fall for phishing emails is less than 60 seconds according to the 2024 Verizon Data Breach Investigations Report . With stolen credentials being one of the most popular methods of attack, businesses face increasing risks as these types of cyber threats become more complex and dangerous. How Phishing and Spoofed Domains Work Phishing attacks aim to trick employees into revealing sensitive information, often through: Fraudulent Email Links – These emails appear to be from trusted sources but contain malicious links that install malware or steal login credentials. Look-Alike Domains – Hackers create fake websites that resemble real business portals, altering a single character in the domain (e.g., “micr0soft.com” instead of “microsoft.com”). Credential Theft – Once hackers obtain login credentials, they sell them on the dark web, leading to widespread data breaches. Red Flags: How to Identify a Phishing Email Unusual Sender Addresses – Cybercriminals often spoof email addresses to look like trusted sources. Carefully inspect the sender's domain name for typos, extra characters, or strange formatting. A genuine email from "paypal.com" could be faked as "paypall.com" or "paypal-support.com." Urgent or Threatening Language – Many phishing emails attempt to create a sense of urgency, claiming that an account will be suspended, a payment has failed, or legal action is imminent. If an email pressures you into immediate action, be suspicious. Unexpected Attachments or Links – Hover over hyperlinks before clicking to see the actual URL destination. If the web address looks unfamiliar or mismatched with the sender's identity, do not click. Similarly, attachments that appear out of context—especially ZIP files, PDFs, or Word documents—could contain malware. Requests for Sensitive Information – Legitimate organizations will never ask for passwords, Social Security numbers, or banking details via email. If an email requests confidential information, verify with the company directly using a trusted phone number. Generic Greetings or Poor Grammar – Emails that start with “Dear Customer” instead of your name, or those containing awkward phrasing and misspellings, often indicate phishing attempts. Many cybercriminals operate internationally and use machine translations, leading to unnatural wording. Best Practices to Protect Your Business Train Employees Regularly – Frequent security awareness training helps employees recognize phishing attempts. Past studies by Proofpoint show that companies with ongoing cybersecurity training reduce phishing-related breaches by up to 60%. Implement simulated phishing tests to reinforce learning. Enable Multi-Factor Authentication (MFA) – MFA significantly decreases the chances of an account being compromised, even if login credentials are stolen. Microsoft reports that MFA can block over 99% of automated cyberattacks . Ensure all employees activate MFA for business accounts. Verify Requests Independently – If an email asks for sensitive actions (e.g., wire transfers, login changes, or software downloads), confirm the request through a known and trusted contact method. Never use the phone number or link provided in the email —instead, visit the company's official website or call using a verified number. Monitor and Filter Emails – Implement robust email security tools that automatically flag suspicious messages. Advanced filtering systems, like those offered by Barracuda Networks, can block over 90% of phishing emails before they reach inboxes. Encourage a Report-First Culture – Employees should feel empowered to report suspicious emails even if they are unsure. IT teams can analyze these reports to strengthen cybersecurity measures. Early detection prevents widespread damage. Use a Password Manager – Employees often reuse passwords across multiple accounts, increasing security risks. Encourage the use of password managers like 1Password or LastPass to generate and store complex passwords securely. New Tactic: The Rise of QR Code Phishing ("Quishing") QR code phishing, or "quishing," is a new phishing tactic gaining momentum as attackers exploit the widespread use of QR codes. Unlike traditional phishing, which relies on malicious email links, quishing uses QR codes to redirect users to fake websites designed to steal login credentials. Several factors contribute to quishing's success: Ubiquity : QR codes are now commonly used for payments, tickets, and documents, reducing suspicion when they appear in emails. Minimal Text : Unlike traditional phishing emails, quishing messages often contain little text, making them harder for security systems to flag. Mobile Vulnerability : QR codes are scanned on personal devices, which typically lack the protection of corporate systems. According to Abnormal Security , 90% of quishing attacks involve credential phishing , where users are tricked into entering sensitive data. Another common tactic is using fraudulent MFA alerts, which account for 27% of attacks , while 21% involve fake document-signing requests . Final Thoughts At the end of the day, protecting your company from phishing and cyber threats requires more than just technology—it’s about the people behind it. By fostering a culture of awareness and encouraging open communication, you empower your employees to be the first line of defense. Together, with vigilance and the right tools in place, you can ensure the safety of your sensitive data and build a more secure future for your business.
Employee Appreciation Day, which falls on March 7th this year, is an ideal occasion to express gratitude for the hard work and dedication of your employees. At Simco, we recognize that employee appreciation shouldn’t be limited to just one day, but this day presents a special opportunity to go above and beyond in showing your team how much they mean to the success of your organization. When employees feel recognized and valued, it enhances morale, engagement, and ultimately, productivity. Here are several thoughtful and impactful ways to celebrate Employee Appreciation Day, creating lasting positive effects for both your employees and your company. 1. Personalized Appreciation Nothing shows employees you truly value them more than personalized recognition. Tailor your appreciation efforts to each individual, acknowledging their unique contributions and the impact they’ve made. Personalized gestures help employees feel recognized for the specific work they’ve done, making the appreciation feel authentic and meaningful. You can: Write Personalized Thank-You Notes : Take the time to write handwritten notes to your employees, thanking them for their specific achievements and how they contribute to the company’s overall success. Publicly Acknowledge Contributions : During a company meeting or via a group email, recognize each team member's individual contributions, celebrating their efforts with concrete examples. Employee Spotlights : Feature standout employees in your internal newsletter or on social media to highlight their unique strengths and hard work. 2. Host an Engaging Celebration Employee Appreciation Day is an excellent time to host a celebration that brings everyone together, whether virtually or in person. A well-planned event can boost morale and provide a chance for employees to connect with one another outside of their usual work routines. Ideas for celebration include: Catered Meals or Special Treats : Provide lunch, snacks, or a special treat to make the day feel celebratory. A fun lunch or dessert bar can offer an opportunity for employees to mingle and bond. Themed Events : Host a fun, themed event such as a retro office party or a “thank you” happy hour where employees can unwind and enjoy themselves. Virtual Celebration : For remote or hybrid teams, set up a virtual event like a game or trivia session where employees can engage and laugh together. 3. Offer Tangible Tokens of Appreciation While a simple thank-you is powerful, offering a meaningful gift can take employee appreciation to the next level. Thoughtful rewards can show your team that you not only recognize their hard work but are also willing to invest in their well-being. Consider: Gift Cards : Offer gift cards to popular retailers, restaurants, or online stores, allowing employees to pick out something they personally enjoy. Wellness Incentives : Gifts that promote health and wellness—such as fitness trackers, yoga classes, or access to mental health resources—show employees you care about their overall well-being. Company Merchandise : High-quality, branded merchandise like apparel, accessories, or tech gadgets can serve as a lasting reminder of your appreciation. 4. Invest in Professional Development One of the most meaningful ways to honor your employees is by helping them grow professionally. Employee Appreciation Day is a great time to invest in their future, whether through formal training, new opportunities, or fostering leadership skills. Ways to offer growth opportunities include: Learning Stipends : Offer financial support for employees to pursue further education, certifications, or online courses that align with their career goals. Internal Development Programs : Launch mentorship initiatives or leadership programs that enable employees to expand their skill sets within the organization. Growth Opportunities : Encourage employees to explore new roles or responsibilities that align with their career aspirations, reinforcing your commitment to their long-term success. 5. Encourage Peer Recognition Employee appreciation doesn’t have to be a one-way street from management to employees. Encouraging peer-to-peer recognition helps build a strong team culture, where employees feel supported and valued by their colleagues as well. This helps foster camaraderie and teamwork, which benefits the entire organization. Ideas for peer recognition: Peer-to-Peer Appreciation Platforms : Create an internal platform where employees can nominate or thank their colleagues for their contributions, highlighting specific ways they've gone above and beyond. Recognition Wall : Set up a virtual or physical wall where employees can post messages of appreciation for their peers, encouraging a culture of gratitude. Monthly Recognition : Implement a peer-nominated “Employee of the Month” program to recognize and reward employees for their ongoing contributions. 6. Give Back Employee Appreciation Day also provides an opportunity to show gratitude by giving back to the community. Many employees value working for companies that have a strong sense of corporate social responsibility. By organizing a charitable event or initiative, you demonstrate that your organization cares about making a positive difference beyond the workplace. Ideas for giving back include: Company Volunteer Days : Organize a day of service where employees can volunteer at a local charity or nonprofit, allowing them to contribute to causes they care about while bonding with their colleagues. Matching Donations : Offer to match employee donations to their favorite charities, demonstrating that you support their personal values and causes. Charitable Fundraising Events : Host fundraising activities or auctions with proceeds going to a charitable organization chosen by the team. 7. Seek Feedback Finally, a key part of showing appreciation is listening to your employees and gathering feedback on how they feel valued. Employee Appreciation Day offers the perfect occasion to ask for input on what makes them feel appreciated and what could be improved. This helps ensure that future efforts are even more meaningful. Ways to gather feedback: Anonymous Surveys : Send out a survey asking employees what makes them feel most appreciated and if they have any suggestions for improving recognition practices. One-on-One Check-ins : Arrange individual meetings with employees to hear their thoughts on workplace culture and recognition, providing an opportunity for honest feedback. Cultivating a Culture of Appreciation Year-Round Employee Appreciation Day is a special occasion, but the benefits of recognizing your team should last well beyond this single day. When employees feel consistently valued and appreciated, it leads to higher morale, greater job satisfaction, and increased engagement. By investing in recognition efforts, offering meaningful rewards, and fostering a culture of appreciation, you ensure that your team remains motivated, happy, and productive all year long. At Simco, we believe that lifting and supporting employees is integral to creating a thriving workplace. Whether you celebrate Employee Appreciation Day with gifts, events, or personalized recognition, taking the time to show gratitude is a small gesture that can have a lasting impact on both your employees and your business.
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The future of work is changing fast, and HR leaders are taking notice. More than half of companies are planning to switch their HCM platform this year—but not just for any solution. They’re looking for intelligent, scalable, and AI-driven technology that doesn’t just process payroll but actively enhances business operations. The days of rigid, outdated systems are over. Now, businesses need platforms that adapt, automate, and evolve alongside them. At Simco, we’re passionate about delivering the most advanced, transformative solutions to our clients. That’s why we’ve partnered with isolved, a recognized leader in the HCM space, to provide our clients with a powerful, AI-enabled platform that makes workforce management effortless. With a focus on automation, predictive analytics, and employee experience, isolved is changing the game for small and mid-sized businesses—and we’re here to help you make the most of it. Why isolved Stands Out in the HCM Market For the second consecutive year, Nucleus Research has named isolved a leader in its HCM Value Matrix for Small and Medium-Sized Businesses (SMBs). The firm’s analysis highlights isolved’s enterprise-grade functionality, designed specifically for SMBs looking to streamline operations, enhance compliance, and leverage AI to drive efficiency. isolved’s adaptability ensures it evolves alongside customer needs. Whether an organization’s HR function matures or its priorities shift, isolved is uniquely positioned to support its success through continuous innovation. In 2024, the company launched 480+ product enhancements directly driven by direct customer feedback. Nucleus Research’s report also highlights several key updates, including: isolved's Candidate Match Tool , an AI-powered feature that evaluates and ranks candidates, streamlining the hiring process. Enhanced Talent Acquisition Services , including recruitment process outsourcing (RPO), job placement assistance, and comprehensive hiring solutions for quick-service restaurants (QSRs). A Broadened Content Library, now with over 95,000 courses designed for employee training, compliance, and professional development. A Next-Gen Time Clock , featuring advanced facial recognition and remote access for secure and accurate time tracking. The Power of Partnership: Simco + isolved While technology is the foundation, the real value comes from how it’s applied. At Simco, we don’t just provide software—we offer a full-service HCM and advisory solution, ensuring that all aspects of workforce management integrate seamlessly. Our clients benefit from: A Dedicated Client Success Manager – Your go-to resource who oversees your relationship with Simco, ensuring that every service—HCM, HR advisory, benefits, insurance, and retirement—works together without gaps. A Fully Integrated HCM & Advisory Solution – No need to juggle multiple vendors for payroll, HR advisory, employee benefits, commercial insurance, and 401(k)/retirement plans. Simco is your one-stop shop for all workforce solutions. Strategic Guidance & Ongoing Optimization – We help businesses maximize their investment in HCM technology while aligning it with compliance, employee engagement, and long-term growth goals. As businesses evolve, so do their workforce management needs. By combining isolved’s leading-edge technology with Simco’s hands-on service and industry expertise, we help businesses stay ahead of change, improve efficiency, and create better employee experiences. Ready to explore the future of HCM? Contact us today to learn more about how we can transform your workforce operations!
Cybercriminals continue to evolve their tactics, making phishing attacks more sophisticated and harder to detect. Every day, countless phishing emails reach inboxes, often with the intent to steal sensitive information or spread malware. Unfortunately, many of these attacks succeed in just a matter of seconds— the median time for users to fall for phishing emails is less than 60 seconds according to the 2024 Verizon Data Breach Investigations Report . With stolen credentials being one of the most popular methods of attack, businesses face increasing risks as these types of cyber threats become more complex and dangerous. How Phishing and Spoofed Domains Work Phishing attacks aim to trick employees into revealing sensitive information, often through: Fraudulent Email Links – These emails appear to be from trusted sources but contain malicious links that install malware or steal login credentials. Look-Alike Domains – Hackers create fake websites that resemble real business portals, altering a single character in the domain (e.g., “micr0soft.com” instead of “microsoft.com”). Credential Theft – Once hackers obtain login credentials, they sell them on the dark web, leading to widespread data breaches. Red Flags: How to Identify a Phishing Email Unusual Sender Addresses – Cybercriminals often spoof email addresses to look like trusted sources. Carefully inspect the sender's domain name for typos, extra characters, or strange formatting. A genuine email from "paypal.com" could be faked as "paypall.com" or "paypal-support.com." Urgent or Threatening Language – Many phishing emails attempt to create a sense of urgency, claiming that an account will be suspended, a payment has failed, or legal action is imminent. If an email pressures you into immediate action, be suspicious. Unexpected Attachments or Links – Hover over hyperlinks before clicking to see the actual URL destination. If the web address looks unfamiliar or mismatched with the sender's identity, do not click. Similarly, attachments that appear out of context—especially ZIP files, PDFs, or Word documents—could contain malware. Requests for Sensitive Information – Legitimate organizations will never ask for passwords, Social Security numbers, or banking details via email. If an email requests confidential information, verify with the company directly using a trusted phone number. Generic Greetings or Poor Grammar – Emails that start with “Dear Customer” instead of your name, or those containing awkward phrasing and misspellings, often indicate phishing attempts. Many cybercriminals operate internationally and use machine translations, leading to unnatural wording. Best Practices to Protect Your Business Train Employees Regularly – Frequent security awareness training helps employees recognize phishing attempts. Past studies by Proofpoint show that companies with ongoing cybersecurity training reduce phishing-related breaches by up to 60%. Implement simulated phishing tests to reinforce learning. Enable Multi-Factor Authentication (MFA) – MFA significantly decreases the chances of an account being compromised, even if login credentials are stolen. Microsoft reports that MFA can block over 99% of automated cyberattacks . Ensure all employees activate MFA for business accounts. Verify Requests Independently – If an email asks for sensitive actions (e.g., wire transfers, login changes, or software downloads), confirm the request through a known and trusted contact method. Never use the phone number or link provided in the email —instead, visit the company's official website or call using a verified number. Monitor and Filter Emails – Implement robust email security tools that automatically flag suspicious messages. Advanced filtering systems, like those offered by Barracuda Networks, can block over 90% of phishing emails before they reach inboxes. Encourage a Report-First Culture – Employees should feel empowered to report suspicious emails even if they are unsure. IT teams can analyze these reports to strengthen cybersecurity measures. Early detection prevents widespread damage. Use a Password Manager – Employees often reuse passwords across multiple accounts, increasing security risks. Encourage the use of password managers like 1Password or LastPass to generate and store complex passwords securely. New Tactic: The Rise of QR Code Phishing ("Quishing") QR code phishing, or "quishing," is a new phishing tactic gaining momentum as attackers exploit the widespread use of QR codes. Unlike traditional phishing, which relies on malicious email links, quishing uses QR codes to redirect users to fake websites designed to steal login credentials. Several factors contribute to quishing's success: Ubiquity : QR codes are now commonly used for payments, tickets, and documents, reducing suspicion when they appear in emails. Minimal Text : Unlike traditional phishing emails, quishing messages often contain little text, making them harder for security systems to flag. Mobile Vulnerability : QR codes are scanned on personal devices, which typically lack the protection of corporate systems. According to Abnormal Security , 90% of quishing attacks involve credential phishing , where users are tricked into entering sensitive data. Another common tactic is using fraudulent MFA alerts, which account for 27% of attacks , while 21% involve fake document-signing requests . Final Thoughts At the end of the day, protecting your company from phishing and cyber threats requires more than just technology—it’s about the people behind it. By fostering a culture of awareness and encouraging open communication, you empower your employees to be the first line of defense. Together, with vigilance and the right tools in place, you can ensure the safety of your sensitive data and build a more secure future for your business.
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