Page:United States Statutes at Large Volume 100 Part 3.djvu/203

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 2011

^ "(B) In this paragraph: "(i) The term 'large group health plan' has the meaning given such term in section 5000(b) of the Internal Revenue Code of 1986. "(ii) The term 'active individual' means an employee (as may be defined in regulations), the employer, an individual associ1 ated with the employer in a business relationship, or a member of the family of any of those persons. "(C) The provisions of subparagraph (B) of paragraph (3) shall apply to coordination of payment under this paragraph in the case of large group health plans in the same manner as they apply to coordination of payment under paragraph (3) in the case of group health plans. "(D) The preceding provisions of this paragraph shall only apply to items and services furnished on or after January 1, 1987, and before January 1, 1992.".

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(b) ESTABLISHMENT OF PRIVATE CAUSE OF ACTION WHERE MEDICARE

SECONDARY.—Such section is further amended by adding at the end the following new paragraph: "(5) There is hereby created a private cause of action for damages (which shall be in an amount double the amount otherwise provided) in the case of a workmen's compensation law or plan, automobile or liability insurance policy or plan or no fault insurance plan, group health plan, or large group health plan which is made a primary payer under paragraph (1), (2), (3), or (4), respectively, and which fails to provide for primary payment (or appropriate reimbursement) in accordance with such respective paragraphs."

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(c) SPECIAL ENROLLMENT PERIODS.—

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(1) Section 1837(i)(l) of such Act (42 U.S.C. 1395p(i)(l)) is amended by adding at the end the following: "In the case of an individual who has not attained the age of 65, at the time the individual first satisfies paragraph (1) of section 1836, is en- 42 USC 1395o. rolled in a large group health plan as an active individual (as those terms are defined in section 1862(b)(4)(B)), and has elected 42 USC 1395y. not to enroll (or to be deemed enrolled) under this section during the individual's initial enrollment period, there shall be a special enrollment period described in paragraph (3)(B).". (2) Section 1837(i)(2) of such Act (42 U.S.C. 1395p(i)(2)) is amended by adding at the end the following: "In the case of an individual who has not attained the age of 65, has enrolled (or has been deemed to have enrolled) in the medical insurance program established under this part during the individual's initial enrollment period, or is an individual described in the vsesi t^c' second sentence of paragraph (1), has enrolled in such program during any subsequent special enrollment period under this subsection during which the individual was not enrolled in a large group health plan as an active individual (as those terms are defined in section 1862(b)(4)(B)), and has not terminated enrollment under this section at any time at which the individual is not enrolled in such a large group health plan as an active individual, there shall be a special enrollment period described, • in paragraph (3)(B).". (3) Section 1837(i)(3) of such Act (42 U.S.C. 1395p(i)(3)) is Ante, p. 171. amended— (A) by inserting "(A)" after "(3)", (B) by inserting "the first sentences o f after "referred to in, (C) by adding at the end the following new subparagraph:

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