Posted on behalf of Elizabeth Vollmar, J.D.
The Centers for Medicare and Medicaid Services (CMS), the federal agency that collects the transitional reinsurance fee (TRF) has announced an April 30, 2015 deadline for claiming certain overpayments of that fee with respect to 2014. Specifically, the deadline applies to overpayments that result from misapplication of a permitted method for determining the annual enrollment count on which the fee is calculated or including individuals in the count for whom the fee was not required. Employers with self-insured plans who paid the TRF for 2014 may wish to review the enrollment counts reported if they have concerns that they may have paid more than required.
IMPORTANT: Employers that did not sponsor a self-insured plan during 2014 were not required to remit the TRF for 2014.
Most of us have given little, if any, thought to the TRF requirements since completing the annual online filing last November or December. For those who could use a refresher, here are some of the more important details:
- The TRF is an annual per capita fee that is required with respect to each and every individual that has coverage under a policy or plan subject to the requirement (e.g., it applies to enrolled spouses and children, not just employees). Insurers and sponsors of self-insured plans are required to pay the TRF with respect to the major medical coverage they provide.
- For fully-insured coverage, insurers are responsible for completing the TRF filing and remitting the TRF. Therefore, employers providing fully-insured coverage don’t need to worry about the TRF filing or the accuracy of the information reported.
- For 2014, the TRF was generally $63 per covered life. (For 2015, it drops to $44 per covered life and, for 2016, it drops to $27.) The TRF is assessed and paid on a calendar-year basis (regardless of plan year).
- For 2014, it could be paid in one installment that is due no later than Jan. 15, 2015, or in two installments, the first of which ($52.50 per covered life) was due no later than Jan. 15, 2015, and the balance ($10.50 per covered life) is due the following Nov. 15.
- Assessment of the TRF is based on an annual enrollment count, and entities required to remit the TRF were to report their annual enrollment counts for 2014 no later than Dec. 5, 2014.
- Using pay.gov, filers reported annual enrollment counts and arranged remittance of TRF payments online.
- Various methods were provided to determine annual enrollment counts, with repeated modifications and changes being announced in agency webcasts, conference calls and FAQs. Confusion about how to count and how to report the count abounded.
The agency has now noted in an announcement that “some contributing entities may have misreported their annual enrollment count for the 2014 benefit year…potentially resulting in an overpayment.” Exactly what should be done to correct any errors and obtain a refund is a bit unclear. The announcement first says that filers “can generally correct these errors by simply refiling a form through pay.gov…with the correct annual enrollment count and CMS refunds the payment associated with the erroneous filing.” It sounds simple.
In the next paragraph, however, the agency states that filers “must send refund requests resulting from annual enrollment count misreporting to CMS by April 30, 2015, or 90 days from the date of their form submission, whichever is later. These requests and other inquiries regarding the reinsurance contribution submission process should be sent to firstname.lastname@example.org. So, it appears that an entity seeking a refund must first re-file its form with the adjusted annual enrollment count and then send an email requesting a refund. And it must do this by April 30, 2015. The guidance notes that the deadline is extended to 90 days after the original filing date if that’s later that April 30, but that would mean that the original filing was delinquent.
The guidance notes that this April 30 deadline does not apply to requests for refunds resulting from paying the fee more than once for the same individual. It also notes that filers cannot now change the counting method they used previously to determine their annual enrollment count – only corrections due to misapplication of the method used are permitted.