On November 25, 2013, the Department of Health and Human Services (HHS) released a Proposed Notice of Benefit and Payment Parameters for 2015 regarding the Affordable Care Act’s Transitional Reinsurance Program (TRP) fee.
The Proposed Notice includes the previously announced carve-outs from the TRP fee for the 2015 and 2016 years for certain self-insured, “self-administered” plans. The Proposed Notice also defines “contributing entity” differently than in prior years as it relates to self-insured group health plans. Under the new definition, to be a contributing entity, a self-insured group health plan must use a third-party administrator in connection with claims processing, adjudication, or plan enrollment. Moreover, the Proposed Notice states that self-insured plans that do not use a third-party administrator for their core administrative processing functions would be excluded from the obligation to make reinsurance contributions. Finally, there is a $44 per capita fee for the 2015 benefit year.
HHS is seeking comment on the types of core administrative functions it should consider in determining whether a self-insured group health plan using a third party administrator is a contributing entity. HHS is also seeking comment on whether a self-insured plan must perform core administrative functions for all health care benefits or only certain benefits.
The full text of the Proposed Notice can be found here.