Claude, I can see how that question would be confusing. However, this form is only required of patients who have Medicare and some other coverage that might be primary to Medicare, such as an employer plan or Workers Compensation. If you have Medicare only, or Medicare/Medigap, or Medicare/Medicaid, you will not be required to complete this form. Some facilities ask everyone to complete it, and in those cases you can answer "no" because you indeed are not covered under an employer plan, even if you are in fact eligible to be carried under that plan.