Reinsurance (RP) FAQ

Guidance for FAQ regarding Other and Other

Program Area: Reinsurance (RP)

Question: How should mother and infant claims costs be treated for the purposes of the reinsurance program?

Answer: In the preamble to the 2014 HHS Notice of Benefit and Payment Parameters (78 FR 15420), we stated that "in operation, issuers will separate infant and mother claims when possible. If an infant claim cannot be separated, HHS will assign the infant to the lowest severity category and the 'term' maturity category. We note that HHS does not intend to unbundle claims in operation." For reinsurance purposes, issuers should similarly unbundle claims whenever practicable - that is to say, whenever it is legally and operationally practicable for an issuer to do so. If an issuer cannot practicably unbundle all infant and mother claims, the issuer must adopt and adhere to a consistent policy for the bundling and unbundling of those claims for purposes of uploading to the Edge Server (for example, a policy providing that claims within 30 days of birth are to be bundled, and claims after that period unbundled). Claims costs that remain bundled will count as the mother's claims costs under the reinsurance program.