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Is it final that Self Insured groups do not have to pay the reinsurance fee?

In a large batch of final rules covering about half a dozen Affordable Care Act policies, the Department of Health and Human Services is giving some self-insured and self-administered health plans a two-year exemption from reinsurance fees.

“We… intend to propose in future rulemaking to exempt certain self-insured, self-administered plans from the requirement to make reinsurance contributions for the 2015 and 2016 benefit years,” HHS officials wrote in a preamble to rules published in the Federal Register.

Employers that self-insure still have to pay the ACA’s transitional reinsurance fee for 2014, set at $63 per plan participant and intended to raise a fund of $25 billion to help cover high claims in state exchange pools.

For 2015 and 2016, it’s not yet clear how broad the exemption will be, but there may be several.

HHS officials wrote that they are clarifying the definition of “contributing entity” under reinsurance regulations to address those employers that may be partially insured and partially self-insured, for instance if medical benefits are self-insured but prescription drug benefits are bought through insurance.

“We proposed this amendment to clarify that, for purposes of determining whether an entity bears liability for reinsurance contributions, a self-insured group health plan includes a group health plan that is partially self-insured and partially insured, but only where the insured coverage does not constitute major medical coverage,” HHS officials wrote.

“This amendment clarifies that if a group health plan is structured in such a manner, the group health plan would be liable for reinsurance contributions under the counting rules applicable to self-insured group health plans…but if the insured component of the group health plan is major medical coverage, the issuer remains liable for the contributions.”

HHS officials are also outlining a payment schedule for contributing entities, with a rough plan to collect in two installments: contributions for reinsurance payments and administrative expenses would be collected at the beginning of the calendar year following the benefit year, and payments to the U.S. Treasury would be collected at the end of the calendar year following the benefit year.