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

Issue Date: October 29, 2014

Program Area: Reinsurance-Contributions (RIC)

Question: If a self-insured group health plan files the prior year's Form 5500 by October 15 of the current benefit year, will the entity be able to use those enrollment counts for the Form 5500 Counting Method for reinsurance purposes, as described in 45 CFR 153.405(e)(3)?

Answer: Applicable to All Reinsurance Contributions Benefit Years: Yes. Pursuant to 45 CFR 153.405(e)(3), which outlines the Form 5500 Counting Method, a plan may use the number of lives covered for the most current plan year calculated based upon the "Annual Return/Report of Employee Benefit Plan" filed with the Department of Labor (Form 5500) for the last applicable time period. Therefore, if a plan uses the Form 5500 Counting Method for determining the Annual Enrollment Count, and the most current plan year calculated based upon the Form 5500 filed with the Department of Labor for the last applicable time period represents a period of time during the prior calendar year, the plan may use this period in determining the plan's Annual Enrollment Count for the current benefit year for the purpose of reinsurance contributions. For the applicable Benefit Years, a plan may use its Form 5500 filed with the Department of Labor as follows: - 2013 Form 5500 for the 2014 Annual Enrollment Count - 2014 Form 5500 for the 2015 Annual Enrollment Count - 2015 Form 5500 for the 2016 Annual Enrollment Count Entities may also reference the "Transitional Reinsurance Program Operational Guidance: Examples of Counting Methods for Contributing Entities" for the applicable benefit year that explains the counting methods available by type of Contributing Entity, summarizes the counting methods, and provides examples for the application of each counting method. To access the document, go to: the Transitional Reinsurance Program webpage at http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Reinsurance-Contributions.html or visit www.regtap.info, select Library, and Filter by "Reinsurance-Contributions" and the applicable benefit year.

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