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 Contributing Entity and Other

Program Area: Reinsurance-Contributions (RIC)

Question: Can a third party, such as a Third Party Administrator (TPA), Administrative Services-only (ASO) contractor, broker, agent or attorney submit reinsurance contributions on behalf of a Contributing Entity and are they required under federal regulations to do so?

Answer: Applicable to All Reinsurance Contributions Benefit Years: Yes, a third party may submit reinsurance contributions on behalf of a Contributing Entity. However, the responsibility to make reinsurance contributions remains with the Contributing Entity, and the decision to delegate the reinsurance contribution submission function resides with the Contributing Entity. The U.S. Department of Health and Human Services (HHS) does not regulate who may submit the reinsurance contributions on behalf of the Contributing Entity. Additionally, HHS regulations do not require a TPA or ASO contractor to perform this function if requested; a TPA's or ASO contractor's obligation to do so would be a function of the arrangement between the TPA or ASO contractor and the Contributing Entity and any applicable state law. A Contributing Entity is responsible for the reinsurance contribution, although the entity may elect to use a TPA or ASO contractor for submission of the entity's enrollment count and transfer of the reinsurance contribution.

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

Issue Date: August 07, 2014

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.