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

Issue Date: August 09, 2016

Program Area: Reinsurance (RP)

Question: What is the coinsurance rate for the 2015 Benefit Year reinsurance payments and when should issuers expect to receive them?

Answer: As noted in the "Transitional Reinsurance Program: Pro Rata Adjustment to the National Coinsurance Rate for the 2015 Benefit Year" Guidance* published on June 17, 2016, reinsurance payments for the 2015 Benefit Year will be made at an estimated 55.1 percent coinsurance rate.* This coinsurance rate is reflected in the "Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2015 Benefit Year."* As indicated in the Adjusted Reinsurance Payment Report emailed to reinsurance-eligible issuers on June 30, 2016, the Centers for Medicare & Medicaid Services (CMS) will remit the 2015 Benefit Year reinsurance payments in the August 2016 payment cycle at an 89.1 percent cycle proration factor. The cycle proration factor is calculated by applying the 55.1 percent coinsurance rate and 2016 Fiscal Year's 6.8 percent holdback rate to issuers' estimated reinsurance payments after CMS has accounted for payment adjustments (including overlapping claims) reported by July 15, 2016. For each reinsurance payment remitted, CMS will email the External Data Gathering Environment (EDGE) Chief Executive Officer (CEO) Designate and alternate contacts an updated Adjusted Reinsurance Payment Report, which will reflect the actual reinsurance payment after applying year-to-date adjustments for the 2015 Benefit Year. For details on payments of sequestered funds, please see FAQ 17162. For details on how reinsurance payment cycle amounts are calculated, please review the Reinsurance Payment series webinar presentation from June 30, 2016, located at https://www.regtap.info/uploads/library/RP_Slides_063016_v1_5CR_070116.pdf. * This guidance is available at https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/2015ProRataCoinsuranceRate.pdf. * The coinsurance rate for the 2015 Benefit Year is subject to change - and may increase or decrease - in light of overlapping claims, differences between projected and actual reinsurance contribution collections, discrepancies and appeals. An issuer's initial, estimated reinsurance payment for the 2015 benefit year may also change. * The Summary Report for the 2015 benefit year is available at https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/June-30-2016-RA-and-RI-Summary-Report-5CR-063016.pdf.

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