Risk Corridors (RC) FAQ
Guidance for FAQ regarding Calculations and Allocation of Payments and Charges to QHPs
Program Area: Risk Corridors (RC)
Question: Which types of plans should be considered when allocating expenses for the risk corridor calculation? Should all non-grandfathered plan expenses (claim and admin) be allocated proportionally based on premium and then the risk corridor calculation done on QHPs only?
Answer: For each market within a state, the claims and admin expenses of all of a QHP issuer's non-grandfathered, ACA-compliant plans should be allocated pro-rata based on the QHP's premiums. In this way, the risk corridors payment or charge amount will reflect the QHP's share of the QHP issuer's market-wide allowable costs and premiums.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 28, 2014
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