As part of the Patient Protection and Affordable Care Act, an Early Retiree Reinsurance Program (ERRP) was created to provide financial assistance for employer groups who provide health plan coverage to early retirees. Providence Health Plan is available to assist employer groups in the application process and ongoing claims submission. Enrollment eligibility ends on January 1, 2014. Visit www.healthcare.gov for more information.
Who is eligible to participate in the program?
Fully insured and self-funded employer group health plans that provide health plan coverage to early retirees are eligible to participate in the program.
What is the process for submitting an application?
Download and complete the HHS application below to become a certified program eligible to receive reimbursement.
Providence Health Plan is available to assist you with the application process. You may also contact your Providence Health Plan Account Manager for further assistance. Required documents are listed and attached below:
How will employer groups be reimbursed?
Reimbursement will be based on an employer group’s plan year. Providence Health Plan will submit eligible claims for reimbursement to HHS on employer groups’ behalf. Providence Health Plan will provide employer groups with a Data Sharing Agreement that will detail requirements and responsibilities of both the employer group and health plan for claims submission.
How will estimated reimbursement amounts be calculated?
Employer groups will receive an estimated reimbursement amount based on book of business data, not group specific data. Year 1 calculations will be made based on estimated claims accumulations from the beginning of the plan year through June 1st (capped at $15,000) plus claims accumulations from June 1st to the end of the plan year (as outlined in the legislation). Year 2 calculations will be estimated based on an entire year’s accumulations (without the before/after June accumulation differences).
How much can employer groups expect to see in reimbursement?
Reimbursement will vary by employer group, based on eligible employees and their dependents and their claims experience during a plan year. Employers will receive reimbursement for 80 percent of paid claims between $15,000 and $90,000 from eligible members during a plan year.
How can employer groups use the reimbursement?
Reimbursements can be used to benefit all plan participants, and not just early retirees. Reimbursement funds must be used to:
- Reduce the plan sponsor’s premium
- Reduce plan participant costs (i.e. premium contribution, deductible, copayment, coinsurance, out-of-pocket maximum)
- Any combination of the above
Reimbursements received in the first year that a sponsor participates may be applied the second year of participation. Reimbursement funds cannot be used as general revenue.
Who can employer groups contact for more information?
Employers groups may contact their Providence Health Plan Account Manager for information and questions about the reimbursement program and application process.