Deadline: Registration on pay.gov and submission of enrollment information must be completed by November 15th of each year. In addition, employers making two payments must complete the second payment by November 15th.
INTRODUCTION
The Affordable Care Act establishes a transitional reinsurance program to help stabilize premiums for coverage in the individual market during the years 2014 through 2016. The statute requires self-insured group health plans (both Grandfathered and Non-Grandfathered), or a third-party administrator (TPA) on behalf of the plan, to make contributions to support payments to individual market issuers that cover high-cost individuals.
For fully insured plans, the insurer is required to make the payment on behalf of an insured major medical plan.
WHAT YOU SHOULD KNOW
The transitional reinsurance program fee applies as of January 1, 2014 regardless of the plan year or policy year. Certain self-insured, self-administered plans are exempt from the reinsurance fees in 2015 and 2016. The reinsurance fee is considered a permissible expense of the plan for purposes of Title I of the Employee Retirement Security Act.
Self-insured group health plans are liable for the fee, although a plan may utilize a third-party administrator or administrative-services-only contractor for transfer of the contributions.
Employer Actions |
---|
Current |
1. Determine which plans are subject to the reinsurance fee.
|
2. Determine which individuals must be counted.
|
3. Determine which counting methods you wish to use.
For further explanation and examples of the various counting methods provided by the Department of Health & Human Services Centers for Medicare & Medicaid Services, Click here. |
4. Determine whether you as the plan sponsor or your TPA will submit enrollment information and the payment as described below.
|
October 1st – November 15th |
Perform covered lives calculation based on data from January 1st through September 30th. |
On or Before November 15th |
Go to www.pay.gov
Payment Schedule for 2015
Regardless of when payment is made, the 2015 payment calculation is based on the covered lives reported on or before November 15, 2015. |
After Enrollment Submission |
Follow the process provided to you on www.pay.gov after the submission of your report. |