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What is the Fee?

Section 1341 of the Affordable Care Act (ACA) established a transactional reinsurance program to stabilize premiums in the individual market inside and outside of marketplaces. This program collects contributions from contributing entities to fund reinsurance payments to:

  • Issuers of non-grandfathered, ACA compliant, reinsurance eligible individual market plans
  • Administrative costs of operating the reinsurance program
  • The General Fund of the US Treasury for the 2014, 2015 and 2016 benefit years

The Reinsurance Fee equals the average number of covered lives in the calendar year multiplied by the national contribution rate, which is $44 for 2015.

Who Needs to pay the Fee?Hand with Stacks of Coins.fw.png

Employers sponsoring self-funded group health plans are required to submit their average, covered lives data (as described above) and schedule their Reinsurance Fee payments no later than November 16, 2015. Download a copy of the form.

Key Dates

  • Employers sponsoring self-funded group health plans are required to submit their 2015 average covered lives data and schedule their payment no later than November 16, 2015. However, CMS strongly encourages contributing entities to file before November 16 to avoid any technical difficulties.
  • The 2015 Reinsurance Fee can be paid in one combined payment or in two installments.
  • The first installment of $33 per average covered life is due no later than January 15, 2016. If an employer chooses the combined payment, the $44 fee must be paid all at once, no later than January 15, 2016.
  • The second installment of $11 per average covered life is due no later than November 15, 2016.
  • For self-funded employers who are paying their 2014 Reinsurance Fee in two installments, the second installment of $10.50 per average covered life is due no later than November 16, 2015.

For more information on how Paypro can assist you with Benefit Administration and reducing your healthcare costs while preserving employee benefits, please contact a Paypro Benefits Specialist today!