Reminder! Transitional Reinsurance Fee – Year 2

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This Withum Weekly Pulse is being issued as an annual follow up to our originally issued October 2, 2014 Pulse entitled Transitional Reinsurance Fee.

Section 1341 of the Affordable Care Act (“ACA”), introduced the Transitional Reinsurance Fee (“Fee”) in an effort to fund reinsurance payments to health insurance issuers that cover high-risk individuals in the individual market and to stabilize insurance premiums in the market for the 2014 through 2016 years. The Fee has also been instituted to pay administrative costs related to the Early Retiree Reinsurance Program.


The ACA established a transitional reinsurance program to provide payments to health insurance issuers that cover high-risk individuals and to more evenly spread the financial risk of issuers. The program, as outlined by the final regulations, is designed to provide issuers with greater payment stability as insurance market reforms are implemented and the state-based health insurance exchanges/marketplaces facilitate increased enrollment. It is expected that the program will reduce the uncertainty of insurance risk in the individual market by partially offsetting issuers’ risk associated with high-cost enrollees. In an effort to fund the program, the ACA created the Fee which is a temporary fee that is assessed on health insurance issuers and plan sponsors of self-funded health plans. The Fee is applicable for the 2014, 2015 and 2016 years and is deductible as an ordinary and necessary business expense.


The Fee is generally applicable to all health insurance plans providing major medical coverage including sponsors of self-insured group health plans. Major medical coverage is defined as health coverage for a broad range of services and treatments, including diagnostic and preventive services, as well as medical and surgical conditions in inpatient, outpatient and emergency room settings. Since COBRA continuation coverage generally qualifies as major medical coverage, the Fee will also apply in this instance. It does not, however, apply to employer provided major medical coverage that is secondary to Medicare.

The Fee, as currently structured, does not apply to various other types of plans including, but not limited to, health savings accounts, employee assistance plans or wellness programs that do not provide major medical coverage, health reimbursement arrangements integrated with a group health plan, health flexible spending accounts and coverage that consists of only excepted benefits (e.g. stand-alone dental and vision).


The Transitional Reinsurance Fee for the 2015 benefit year is equal to $44 per covered life per year. It is expected that the Fee for the 2015 benefit year will generate approximately $8 billion in revenue. The Fee for the 2016 year is expected to be $27 per covered life per year and will raise approximately $5 billion in revenue. Thereafter, the Fee is set to expire and no longer be applicable.


The 2015 ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form will be available on on October 1, 2015. The form for 2014 is also available on this website. Please note there is a separate form for each benefit year. For the 2015 year, the number of covered lives must be reported to the Department no later than November 16, 2015. The Department will then notify reporting organizations no later than December 15, 2015 the amount of the fee that will be due and payable.

As with the 2014 benefit year, the Department of Health and Human Services has given contributing entities two different options to make the payment. Under the first option, the first portion of the Fee, or $33 per covered life, is due and payable no later than 30 days after issuance of the notice from the Department; January 15, 2016. This portion of the Fee will cover reinsurance payments and administrative expenses. The second portion of the Fee, $11 per covered life, will cover Treasury’s administrative costs associated with the Early Retiree Reinsurance Program and will be due no later than November 15, 2016.

Under the second option, contributing entities can opt to pay the full amount, $44 per covered life, by January 15, 2016.


As the number of covered lives is due to be reported no later than November 16th of this year employers should review their types of health coverage and determine which plans are subject to the Transitional Reinsurance Fee. Employers that have fully insured plans should be on the lookout for potential increased premiums as the insurance carrier is responsible to report and pay the Fee on behalf of the plan in these instances.

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Please contact a member of Withum’s Healthcare Services Group at for further questions or assistance.

The information contained herein is not necessarily all inclusive, does not constitute legal or any other advice, and should not be relied upon without first consulting with appropriate qualified professionals for your individual facts and circumstances.

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