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The PPACA 2017 Transitional Reinsurance Fee Submission is due November 15

In addition to the Patient Centered Outcomes Research Institute (PCORI) fee, the transitional reinsurance fee is one of several new fees intended to help fund implementation of the Patient Protection and Affordable Care Act (PPACA). This annual fee, designed to reinsure marketplace exchanges, is being collected over a three-year period from 2014 through 2016 on insured and self-funded plans.

 

For the 2016 benefit year, contributing entities had the option to pay the entire year’s contribution in one payment that was due January 17, 2017, or elect two payments, with the first remittance ($21.60 per covered life) due no later than January 17, 2017, and the second payment ($5.40 per covered life) due no later than November 15, 2017.

 

Who is responsible for making contributions?

 

Insurers and sponsors of self-funded commercial health plans that provide major medical coverage are required to make contributions to the program. This includes health coverage for a wide variety of services and treatments, including diagnostic and preventative services, as well as medical and surgical conditions.

 

Groups subject to the reinsurance fee:

  • Health insurance issuers
  • Self-insured group health plans
  • Retirees and former employees are only subject to the fee to the extent their employer-provided coverage is primary to Medicare (based on Medicare Secondary Payer rules)
  • COBRA beneficiaries are counted for purposes of the fee to the extent the plan provides major medical coverage

Past contribution amounts

2014: $63 per enrollee

2015: $44 per enrollee

2016: $27 per enrollee

 

To submit payment:

You can securely submit your contributions on pay.gov.

 

For more information:

Contact your Rehmann advisor, or visit CMS.gov for additional resources. You can email questions regarding reinsurance contributions to reinsurancecontributions@cms.hhs.gov

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