Reinsurance (RP) FAQ
Guidance for FAQ regarding Payment and Other
Program Area: Reinsurance (RP)
Question: Are student health plans eligible to receive reinsurance payments?
Answer: In accordance with the policy established in the HHS Notice of Benefit and Payment Parameters for 2014, student health plans are not eligible to receive reinsurance payments because student health plans are not subject to the single risk pool requirement of section 1312(c) of the Affordable Care Act and 45 CFR 156.80. Because student health plans are not eligible for reinsurance payments, issuers of student health plans will not need to set up an External Data Gathering Environment (EDGE) Server. However, we note that a student health plan would be considered part of a Contributing Entity's "commercial book of business" and, to the extent that the plan provides major medical coverage, as defined in 45 CFR 153.20, a Contributing Entity must make reinsurance contributions on behalf of their enrollees, absent another exception in 45 CFR 153.400. To the extent a student health plan must make reinsurance contributions, the plan will follow the same operational process as any other Contributing Entity.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 31, 2014
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