Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 19, 2014

Program Area: Reinsurance (RP)

Question: Do reinsurance-eligible Individual Market plans include both Individual and Small Group plans?

Answer: No. In 45 CFR 153.20, a reinsurance-eligible plan means, for the purpose of the Reinsurance (RI) program, any health insurance coverage offered in the Individual Market, except for grandfathered plans and health insurance coverage not required to submit reinsurance contributions under 45 CFR 153.400(a). We note that pursuant to 45 CFR 153.234, a reinsurance-eligible plan's covered claims costs for an enrollee incurred prior to the application of the following provisions do not count towards either the national reinsurance payment parameters or the State supplemental reinsurance payment parameters: 45 CFR 147.102, 147.104 (subject to 147.145), 147.106 (subject to 147.145), 156.80, and subpart B of part 156.

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