Understanding HHS Proposed Transitional Reinsurance Program Under the Affordable Care Act in 2014
Overview:The Knowledge Group has assembled a panel of key thought leaders to provide the audience with an in-depth analysis of the Transitional Reinsurance Program proposed by the Department of Health and Human Services (HHS) under the Affordable Care Act.
Key issues include that will be covered in this course are:
- Transitional Reinsurance Program – Background/Overview
- Major Medical Coverage
- HHS’ New Proposed Rule on Transitional Reinsurance Fees
- Self-Insured, Self-Administered Plans and the Timing of Collection – Exclusions
- Covered Lives Counting Method
- Contributing Entity (i.e., Fee Payers)
Greenberg Traurig, LLP
Greenberg Traurig, LLP
- This program will provide an overview of the transitional reinsurance program under the ACA, including why it was developed, how long it will run, how much it will cost, and who will be impacted.
- This program will focus on clarifying who qualifies as a contributing entity, the counting methods that may be used for determining the applicable transitional reinsurance fee, and the timing of collections.
- The webinar will highlight outstanding issues that contributing entities are preparing for, such as the timing and means by which the transitional reinsurance fee will be collected – which may differ from the way other fees are collected.
Troutman Sanders LLP
Health insurance issuers of fully-insured polices are liable for the fee.
For self-funded major medical coverage, third-party administrators are technically liable to pay the fee, but the proposed regulations clarify that the self-insured plan is ultimately liable for the payment (although the third-party administrators may pay the fee on behalf of the plan sponsor).
Plan sponsors of self-funded plans will submit plan enrollment information to HHS by November 15, 2014. Within 15 days of that submission, HHS will notify the employer of the amount which must be paid as a Reinsurance Fee. The employer then has 30 days to pay the fee, which means that employers generally will pay the first Reinsurance Fee by the end of 2014.
HHS will collect the Reinsurance Fee from “major medical coverage”, meaning that the fees generally will not apply to:
- Benefits that are limited in scope (such as dread disease coverage, hospital indemnification or stand-alone dental or vision coverage) qualify as “excepted benefits”,
- Health Reimbursement Arrangements that are integrated with a self-insured group health plan or health insurance coverage,
- Health Savings Accounts,
- Flexible Spending Arrangements,
- Employee assistance plans, disease management programs or wellness programs that do not provide major medical coverage, or
- Stop-loss or indemnity reinsurance policies.
Retiree health plans are generally required to pay the Reinsurance Fee. However, the proposed regulations exclude from the covered lives count individuals for whom Medicare pays primary and the group health plan pays secondary.
The Reinsurance Fee is calculated by multiplying the number of “covered lives” by the “contribution rate” for the calendar year for all covered plans. The proposed regulations specify four methods, which are similar but not identical to the PCORI Fee methods, to calculate the number of covered live. Plan sponsors may use (1) the actual count method using only the first nine months of the year, (2) the snapshot count method using only the first three-quarters of the year, (3) the snapshot factor method using only the first three-quarters of the year, or (4) the Form 5500 method to determine the number of covered lives. If an employer offers a single plan with both fully insured and self-funded options, the employer must use either the actual count or the snapshot count method. If a plan sponsor maintains two or more self-insured group health plans that collectively provide major medical coverage for the same covered lives, then the multiple plans are treated as a single self-insured group health plan for purposes of the Reinsurance Fee.
Who Should Attend:
- Healthcare Consultants
- Healthcare Law Attorneys, Healthcare Organization (Financial Reporting & Accounting)
- Attorneys and Consultants (Biotech, Pharma, Life Sciences and Healthcare Industries)
- Employee Benefits and Executive Compensation Practicing Lawyers
- Health Insurance Companies Attorneys in Banking & Finance Attorneys, Practice Area: Insurance & Related
- Compliance Officers
- Coverage Attorneys
- Third Party Administrators
- And other interested professionals
Nancy Taylor is Co-Chair of Greenberg Traurig’s Health and FDA Business Group and has advised clients on health care related matters for more than two decades. She has broad experience in areas relating to the Affordable Care Act provisions, CMS reimbursement and policy issues relating to providers and plans, and she has done a significant amount of FDA regulatory work. Prior to joining Greenberg Traurig, Nancy served 10 years as Health Policy Director for the Senate Committee on Labor and Human Resources. She also served as CEO of a start-up medical device company, where she obtained eight product clearances, including securing reimbursement coverage for each product.
Nancy Taylor is Co-Chair of Greenberg Traurig’s Health and FDA Business Group and has advised clients on health care related …
Danielle White is focused on tracking, shaping, and assisting clients on the ongoing evolution and implementation of the Affordable Care Act, particularly with respect to employer requirements, Exchange implementation, and delivery system reform, addressing the needs of a variety of clients ranging from hospital systems, nursing homes, employer groups, Medicare and Medicaid providers and plans, and pharmacy providers. Dani also focuses on broader Medicare and Medicaid payment structure and delivery issues, regulation, and reform.
Danielle White is focused on tracking, shaping, and assisting clients on the ongoing evolution and implementation of the Affordable Care …
Evelyn is a partner in Troutman Sanders’ Employee Benefits & Executive Compensation practice. She represents large public and privately held companies in a broad array of employee benefits and executive compensation matters including tax qualified plans, employee health and welfare plans, severance arrangements and non-qualified deferred compensation. With more 30 years of experience advising boards of directors, compensation committees, senior executives and legal departments, Evelyn brings an in depth knowledge of the laws, the governmental agencies that enforce them and extensive practical experience in addressing the day to day issues that arise in the design and administration of employee benefits.
Evelyn is a partner in Troutman Sanders’ Employee Benefits & Executive Compensation practice. She represents large public and privately held …
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Method of Presentation:
NASBA Field of Study:
Specialized Knowledge and Applications
NY Category of CLE Credit:
Areas of Professional Practice
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About Greenberg Traurig, LLP
Greenberg Traurig, LLP is an international, multi-practice law firm with approximately 1750 attorneys serving clients from 36 offices in the United States, Latin America, Europe, the Middle East and Asia. Greenberg Traurig is among the Top 10 law firms on The National Law Journal's 2013 NLJ 350, an annual ranking of the largest firms in the U.S.
GT provides integrated legal services for clients worldwide. The firm offers a multidisciplinary team, including senior lawyers who have been the chief legal officers at major multinational companies and have spent years solving real-world problems in the business, political and legal environments of major commercial centers. GT’s experience in more than 100 practice areas and their network of contacts throughout the world positions them to help clients achieve their objectives both domestically and in the global marketplace.
About Troutman Sanders LLP
Troutman Sanders LLP is an international law firm with more than 600 lawyers practicing in offices located throughout the United States and Asia. Founded in 1897, the firm’s heritage of extensive experience, exceptional responsiveness and an unwavering commitment to service has resulted in strong, long-standing relationships with clients across the globe. These clients range from multinational corporations to individual entrepreneurs, federal and state agencies to foreign governments, and non-profit organizations to businesses representing virtually every sector and industry. Troutman Sanders lawyers provide counsel and advice in practically every aspect of civil and commercial law related to the firm’s core practice areas: Corporate, Energy and Industry Regulation, Finance, Litigation and Real Estate. The firm has deep substantive and industry knowledge and takes a proactive approach to addressing legal and business challenges.