Reinsurance-Contributions (RIC) FAQ
Guidance for FAQ regarding Calculation / Methodology and Other
Program Area: Reinsurance-Contributions (RIC)
Question: Do covered lives of reinsurance contribution enrollees include contracted employees, retirees, spouses, and dependents?
Answer: Applicable to All Reinsurance Contributions Benefit Years: Yes. Reinsurance contributions are generally based on the number of covered lives within a plan or coverage that provides major medical coverage. The reinsurance contribution required from a Contributing Entity is calculated by multiplying the number of covered lives (determined under a permitted counting method set forth in 45 CFR 153.405(d) through 45 CFR 153.405(g)) during the applicable calendar year for all applicable plans and coverage of the Contributing Entity by the applicable contribution rate for the respective benefit year. Depending on the counting method, the number of covered lives may be greater than the number of participants or employees because covered lives also include contracted employees, retirees, spouses, and dependents (i.e. any covered life enrolled in the plan).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 08, 2014
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