Reinsurance (RP) FAQ
Guidance for FAQ regarding Payment and Calculation / Reconciliation
Program Area: Reinsurance (RP)
Question: Are the reinsurance (RI) payment parameters applied to an issuer's claims costs at the issuer or plan level?
Answer: Reinsurance payment estimates are calculated at the enrollee level. An issuer's plan paid amounts for reinsurance-eligible claims are aggregated to the enrollee-level for all individual plan enrollments for a single issuer in the applicable benefit year. Then, the applicable CSR MOOP adjustment is applied. After this, the applicable benefit year's national parameters are applied to each enrollee's remaining aggregated issuer plan paid amount. Estimated RI payment for each enrollee is summed to arrive at the total estimated RI payment for the issuer. For more information, please see the RI Calculation Guide located in REGTAP Library under the Reinsurance program area.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 02, 2014
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