Reinsurance-Contributions (RIC) FAQ
Guidance for FAQ regarding Calculation / Methodology and Other
Program Area: Reinsurance-Contributions (RIC)
Question: Under the exception set forth in 45 CFR 153.400(a)(1)(iv), can an employer exclude from reinsurance contributions any contributions payable with respect to employees who are eligible for primary Medicare under the Medicare Secondary Payer (MSP) Rules under section 1862(b) of the Act and regulations issued thereunder?
Answer: Applicable to All Reinsurance Contributions Benefit Years: An employee actually receiving primary coverage from Medicare pursuant to the MSP Rules does not need to be counted when the employer is calculating its Annual Enrollment Count for the purposes of reinsurance contributions. In 45 CFR 153.405(a)(1)(iv), we provide that a Contributing Entity must make reinsurance contributions for its self-insured group health plans and health insurance coverage except to the extent that, in the case of employer-provided health coverage, such coverage applies to individuals with respect to which benefits under Medicare are primary under MSP Rules under section 1862(b) of the Social Security Act.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 19, 2013
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.