Risk Corridors (RC) FAQ
Guidance for FAQ regarding Calculations and Other
Program Area: Risk Corridors (RC)
Question: Are Catastrophic Plans included with Individual Plans and therefore, included in Risk Corridors calculations?
Answer: For the purposes of calculating 'allowable costs' in the numerator of the risk corridors calculation, issuers should include the experience of all of their non-grandfathered, ACA-compliant plans in a market (individual or small group) within a State. The risk corridors ratio will be calculated based on this data, which will include the experience of catestrophic plans that meet this definition. Risk corridors payments and charges only apply to qualified health plans (QHPs), as defined at 45 CFR 153.500. To the extent that a catestrophic plan meets the definition of a QHP for the purposes of the risk corridors program (45 CFR 153.500), the plan will be eligible for risk corridors payments or subject to risk corridors charges. If a catestrophic plan is not a QHP, it will not receive or make risk corridors payments or charges.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 20, 2014
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