Reinsurance (RP) FAQ
Guidance for FAQ regarding State Operated and Other
Program Area: Reinsurance (RP)
Question: What are the issuer requirements and deadlines for reinsurance in a State where the State is running its own Risk Adjustment (RA) program but HHS is operating the Reinsurance (RI) program?
Answer: Issuers in a State which elected to operate the RA program but deferred operation of the RI program to HHS are required to comply with the requirements applicable to HHS-operated reinsurance programs. Therefore, an issuer in a State where HHS is operating reinsurance must comply with the data requirements and deadlines set forth in 45 CFR Subpart H, specifically 45 CFR 153.700-153.730. Additionally, as set forth in 45 CFR 153.230, a health insurance issuer of a reinsurance-eligible plan becomes eligible for reinsurance payments from contributions under the national contribution rate when its incurred claims costs for an individual enrollee's covered benefits in a benefit year exceed the national attachment point. As set forth in the HHS Notice of Benefit and Payment Parameters for 2015 for the 2014 benefit year, the national reinsurance payment parameters are as follows: $45,000 attachment point, $250,000 reinsurance cap, and 80% coinsurance rate.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 02, 2014
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