Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 30, 2019

Program Area: CSR Reconciliation (CSR)

Question: When aggregating self-only and other than self-only policies after a change in circumstance, page 16 of the CMS reconciliation manual states that an issuer should aggregate the two (2) policies into one (1) report and calculate separate effective cost-sharing parameters for self-only coverage and other than self-only coverage for the plan variation. Does this also apply to the simplified actuarial value methodology? What if the issuer does not have separate effective cost sharing parameters for self-only and other-than-self?

Answer: Yes, this does apply to the Simplified Actuarial Value (AV) method. Issuers should aggregate policies that change from self to other than self-only in the same variation when using the simplified AV methodology, regardless of whether they calculate separate effective cost-sharing parameters for self-only coverage and other than self-only coverage.

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