2016 Transitional Reinsurance Filing

The ACA requires “contributing entities” to pay fees to support the reinsurance program. A contributing entity is defined as a health insurance issuer or a self-insured group health plan sponsor.   Fees apply to these plans, as described below, for 2014, 2015 and 2016 calendar years.

  • Fully-insured Group Health Plans: For insured health plans, the issuer of the health insurance policy is required to pay reinsurance fees. Although sponsors of fully-insured plans are not responsible for paying the reinsurance fees, issuers will likely shift the cost of the fees to sponsors through premium increases.
  • Self-insured Group Health Plans: For self-insured plans, the plan sponsor is liable for paying reinsurance fees, although a third-party administrator (TPA) or administrative-services-only (ASO) contractor may pay the fee at the plan’s direction. For a plan maintained by a single employer, the employer is the plan sponsor. The Department of Labor (DOL) has advised that paying reinsurance fees constitutes a permissible expense of the plan under ERISA because the payment is required by the plan under the ACA.

According to an FAQ issued by HHS, a third party (such as a TPA, ASO contractor, broker, agent or attorney) may submit reinsurance contributions on behalf of a contributing entity. However, the responsibility to make reinsurance contributions remains with the contributing entity, and the decision to delegate the reinsurance contribution submission function resides with the contributing entity. HHS does not regulate who may submit the reinsurance contributions on behalf of the contributing entity.

How to file and pay fees

For 2016, the annual contribution rate is $27 per enrollee per year, or $2.25 per month.  Enrollment counts are to be submitted no later than November 15, 2016 with payments made by January 17, 2017 through Pay.gov.  For additional details see Instructions for Completing the 2016 TRF Filing

 

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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.