Skip to main content
U.S. flag

An official website of the United States government

Return to Search

Reinsurance-Contributions (RIC) FAQ

Guidance for FAQ regarding Discrepancy - Calculation and Submission and 2015 Benefit Year

Final

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

Issue Date: September 18, 2015

Program Area: Reinsurance-Contributions (RIC)

Question: What is the timing associated to request a refund if a Contributing Entity determines it misreported its Annual Enrollment Count for either the 2015 or 2016 benefit years?

Answer: Applicable to Reinsurance Contributions 2015 and 2016 Benefit Years: The Centers for Medicare & Medicaid Services (CMS) is aware that some Contributing Entities may misreport their Annual Enrollment Counts due to misapplying an allowable counting method under 45 CFR 153.405(d) through (g) or including individuals in their Annual Enrollment Counts who are exempt from consideration for purposes of reinsurance contributions under 45 CFR 153.400(a), potentially resulting in an overpayment. On April 14, 2015, CMS issued guidance for the 2015 and 2016 benefit years stating that "refund requests must be submitted 90 days from the date of Form submission (available at: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Downloads/Transitional-Reinsurance-Program-Timing-of-Contributions-Refund-Requests-Due-to-Annual-Enrollment-Count-Misreporting.pdf)". This deadline does not apply when a Contributing Entity requests a refund because it has paid reinsurance contributions more than once for the same covered life. Therefore, to enable CMS to provide issuers with their respective reinsurance payment amounts, for the 2015 and 2016 benefit years, refund requests resulting from Annual Enrollment Count misreporting must be submitted 90 days from the date of Form submission. These requests and other inquiries regarding the reinsurance contribution submission process should be sent to reinsurancecontributions@cms.hhs.gov. Please note that a Contributing Entity that correctly applied one (1) of the counting methods set forth in 45 CFR 153.405(d) through (g) cannot request to change its Annual Enrollment Count and associated payment after the reporting deadline for the applicable benefit year. Counting methods do not need to be consistent across benefit years and a Contributing Entity could elect to use a different counting method as applicable under 45 CFR 153.405(d) through (g) for the 2015 and 2016 benefit years.

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.