Some third-party administrators will provide assistance, at least with tallying the membership, but the self-funded groups themselves are ultimately responsible for reporting their enrollment counts and paying their fees.

The methodologies defined by the Department of Health and Human Services (HHS) for counting the average number of covered lives are outlined below:

• Actual Count: Count the total covered lives for each day of the plan year and divide by the number of days in the plan year.
• Snapshot Dates: Count the total number of covered lives on a single day in a quarter (or more than one day) and divide the total by the number of dates on which a count was made. The date or dates must be consistent for each quarter. 
• Snapshot Factor: In the case of two tiered coverage, determine the sum of: (1) the number of participants with self-only coverage, and (2) the number of participants with other than self-only coverage multiplied by 2.35, then use the Snapshot Date method as above.
• Form 5500 Method (for those with 100+ participants):  Assuming the coverage allows for dependents to enroll, the average number of total lives is the sum of total participants covered at the beginning and the end of the plan year, as reported on the Form 5500.

The 2016 ACA Reinsurance Annual Enrollment Count Submission Form can be submitted online at: https://www.pay.gov/public/form/start/77704988. Please note that there is a specific form for each benefit year. The form will auto-calculate the annual contribution amount to be remitted based on the annual enrollment count and the contributing entity will then schedule payment for the calculated reinsurance contributions on the payment page.

Reinsurance Fees can be paid in one or two installments:

• One installment:   $27.00 per covered life due January 17, 2017

• Two installments: $21.60 per covered life due January 17, 2017

                                     $5.40 per covered life due November 15, 2017

Fully insured plans already have this fee calculated into their plan premium.  Health Reimbursement Arrangements (HRA), a type of self-funded plan that does have to report and pay PCORI fees each July, are NOT subject to the reinsurance fee.

If you have questions, see the Frequently Asked Questions at https://www.pay.gov/WebHelp/HTML/payments_frequently.html or This email address is being protected from spambots. You need JavaScript enabled to view it. here at Fall River!