HHS Details Fees to Be Paid, Provides Guidance for Transitional Reinsurance Program

By Jerry Geisel

Nov. 30, 2012

Eagerly awaited proposed rules issued Nov. 30 by the U.S. Department of Health and Human Services detail how much employers will have to pay to fund the health care reform law-created Transitional Reinsurance Program, and answer many other questions employers have raised about the program.

Much of the $25 billion in assessments—to be paid annually over a three-year period—will be used to partially reimburse commercial insurers writing policies for individuals with high health care costs.

The first-year assessment, HHS proposed, will be $63 for each health care plan participant, which is at the lower end of projections previously made by benefit experts.

Still, the assessments for the obscure but costly reinsurance program will be substantial. The first-year tab for an employer with a 100,000 enrollees in its health care plans, for example, would be $6.3 million.

Plan administrators will be required to send plan enrollment counts to HHS by Nov. 15, 2014. HHS then will send out bills by Dec. 15, 2014, with payments due 30 days later.

Originally, HHS had proposed that the first-year payment be made by Jan. 15, 2014, and that the payments be made quarterly rather than annually.

“This is as good as it can get for employer-sponsored plans, given the constraints of the law itself,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, New Jersey.

HHS didn’t propose what the per-health-care-plan-participant fee would be in the second and third years of the program. But, based on the methodology laid down by HHS, Stover estimated that the per-participant fee would be about $42 in 2015 and $26 in 2016.

Under the law, the fee is supposed to generate $12 billion in revenue in 2014, $8 billion in 2015 and $5 billion in 2016.

Other issues for which employers sought guidance and that were resolved by HHS include:

• The fee will apply to those enrolled in “major medical plans.” That would mean, for example, that the fee would not be assessed on employees enrolled in just dental or vision care plans. In addition, in the case of employees enrolled in high-deductible health care plans linked to health savings accounts or health reimbursement arrangements, only one fee would be assessed.

• The fee would not apply to retirees enrolled in Medicare and receiving supplemental coverage from their former employers. However, the fee would be assessed on retired employees not yet eligible for Medicare and receiving health care coverage from their former employers.

• The fee would apply to former employees and their dependents receiving Consolidated Omnibus Budget Reconciliation Act continuation coverage.

In the case of fully insured employers, the fee would be paid by insurers. For self-funded plans, third-party administrators are to remit the fee on behalf of their clients.

Jerry Geisel writes for Business Insurance, a sister publication of Workforce Management. Comment below or email

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Jerry Geisel writes for Business Insurance, a sister publication of Workforce Management.

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