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

Issue Date: February 02, 2015

Program Area: Risk Corridors (RC)

Question: If a small group market purchases a Qualified Health Plan (QHP) and subsequently becomes a large group market, should enrollment data for the large group market be excluded from Risk Corridor calculations?

Answer: If a small group issuer becomes a large group market issuer in the middle of the year (2014), only the experience for the months that the issuer was a small group issuer should be reported for Risk Corridors calculation purposes. Please note, the Risk Corridors program uses the employee counting method established in state law to determine employer size.

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