Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 29, 2014

Program Area: Reinsurance-Contributions (RIC)

Question: Can the Centers for Medicare & Medicaid Services (CMS) explain the "Type of Contributing Entity" section of the Supporting Documentation (.CSV file)?

Answer: Applicable to All Reinsurance Contributions Benefit Years: The "Type of Contributing Entity" section of the Supporting Documentation (.CSV file) is determined based on whether the entity is a Health Insurance Issuer (HII) or self-insured group health plan (SI). If the entity is a self-insured group health plan, then the entity must determine whether the health plan includes Multiple Group Health Plans Multiple Plan Treatment (MGHPM) or Multiple Group Health Plans Single Plan Treatment (MGHPS) and how they are reported. Therefore, Multiple Group Health Plans Single Plan Treatment (MGHPS) means that the plan sponsor chooses to treat the multiple group health plans as a single group health plan for purposes of calculating the reinsurance contribution Annual Enrollment Count. Multiple Group Health Plans Multiple Plan Treatment (MGHPM) means that the plan sponsor treats the multiple plans as separate group health plans, where the plan sponsor determines the number of covered lives under each separate group health plan as if the separate group health plan provided major medical coverage (i.e., is its own plan for which reinsurance contributions are required). If the plan sponsor maintains multiple group health plans, the selected counting method used for reporting enrollment counts, pursuant to 45 CFR 153.405(g) must be considered. Pursuant to 45 CFR 153.405(g), a Contributing Entity may be multiple group health plans including an insured plan maintained by the same plan sponsor that collectively provides major medical coverage for the same covered lives simultaneously, or multiple self-insured group health plans maintained by the same plan sponsor that collectively provides major medical coverage for the same covered lives simultaneously. Pursuant to 45 CFR 153.405(g)(1), if there are multiple group health plans maintained by the same plan sponsor, the plan sponsor generally must treat the multiple plans as a single group health plan for purposes of calculating the reinsurance contribution Annual Enrollment Count. However, the plan sponsor may also treat the multiple group health plans as separate group health plans if the plan sponsor determines the number of covered lives under each separate group health plan as if each separate group health plan provided major medical coverage (i.e., is its own plan for which reinsurance contributions are required). If a plan sponsor that maintains multiple group health plans that collectively provide major medical coverage for the same covered lives simultaneously and does not include an insured plan chooses aggregate reporting under 45 CFR 153.405(g)(1), the plan sponsor can only claim the self-insured, self-administered exemption if all of its self-insured coverage options meet the criteria for being self-administered as outlined in the definition of Contributing Entity under 45 CFR 153.20. If a plan sponsor that maintains multiple group health plans that collectively provide major medical coverage for the same covered lives simultaneously includes an insured plan chooses aggregate reporting under 45 CFR 153.405(g)(1), the plan sponsor cannot claim the self-insured, self-administered exemption in light of the insured plan. However, if a plan sponsor chooses to report each coverage option separately under 45 CFR 153.405(g)(1), that is the plan sponsor chooses to treat the multiple plans as separate group health plans and determines the number of covered lives of reinsurance contribution enrollees under each separate group health plan as if the separate group health plan provided major medical coverage (that is, as its own plan for which reinsurance contributions are required), then the plan sponsor could claim the self-insured, self-administered exemption for any self-insured coverage option that is deemed self-administered pursuant to the definition of Contributing Entity under 45 CFR 153.20.

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