Reinsurance (RP) FAQ
Guidance for FAQ regarding Payment and Calculation / Reconciliation
Program Area: Reinsurance (RP)
Question: Can the Centers for Medicare & Medicaid Services (CMS) provide information on the adjustment of the Maximum Out-of-Pocket (MOOP)?
Answer: CMS provides issuers with advance Cost Sharing Reduction (CSR) payments for Marketplace plan enrollees who are participating in CSR-eligible plans. In calculating the reinsurance payment for CSR plans, CMS applies a MOOP adjustment to account for the advance CSR payment. The MOOP adjustment is the MOOP difference between the CSR plan and the corresponding standard plan. This adjustment does consider various scenarios such as family policy and change in family structure during the reinsurance payment calculation. For more information, issuers should refer to the Reinsurance Calculation Guide, posted in the REGTAP Library under the Reinsurance program area.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2015
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