US · guidance
CMS Pub. 100-16, ch. mc86c18b, § 150.1
Definition of Employer Group Health Plan (EGHP) or Employer
Plan
(Rev. 30, 09-05-03)
When used in context of entitlement to Medicare based solely on ESRD, these terms
mean any health organization that:
• Is paid for by, or contributed to by, an employer; and
• Provides medical care, directly or through other methods such as insurance or
reimbursement to current or former employees, or to current or former employees
and their families.
It includes the Federal Employees Health Benefits (FEHB) program. Employees pay all
plans, i.e., group health plans under the auspices of an employer that do not receive any
contributions from the employer, also meet the definition of EGHP.
NOTE: Under this provision, Medicare is secondary to EGHPs, regardless of the
number of employees who work for the employer.
History
(Rev. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
de2ddef31f4419f6f6f43c8e3a4e3addb429f9856eb86840a27e9559437838d4
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