Under the Affordable Care Act, health insurance issuers and self-funded group health plans are required to fund a Transitional Reinsurance Program from 2014 to 2016. This program is designed to stabilize premiums in the individual market inside and outside of the Marketplaces and will fund reinsurance payments for those insurers covering high risk individuals.
Self-funded plans fund and remit the Reinsurance Fee, which is assessed on a per capita basis. A fee of $5.25 per member per month ($63 per year) is required for 2014 – decreasing in subsequent years ($3.67 PMPM/$44 per year in 2015, with 2016 fees TBD). The payment for the 2014 calendar year is due to the department of Health and Human Services by January 15, 2015 if paying in full. A two-payment option is available which requires a first installment of $52.50 PMPY by January 15, with the remaining $10.50 PMPY fee due in Q4. Membership counts are determined based on the first nine months of the calendar year, with counts submitted to HHS once per year.
Compliance assistance is a standard part of our client service. For questions or help with these ACA requirements, please give us a call.
In cooperation with NAEBA