Federal Regulatory Guidance and Actions: Reinsurance Program for Early Retirees

NCSL Resources

CAD flagThis is one in a series of NCSL documents offering assistance to states in interpreting and implementing the Affordable Care Act.

Reinsurance Program for Early Retirees

Title I, Subtitle B, Section 1102

Requires the Department of Health and Human Services (HHS) to establish a temporary program within 90 days of enactment (June 1, 2010) for the purpose of providing reimbursement to participating employment‐based plans for a portion of the cost of health benefits for early retirees, individuals 55 and over, and their spouses, surviving spouses and dependents. Beginning with plan years on or after Oct. 1, 2011, HHS will reimburse certain claims between $15,000 and $90,000.


Guidance/Information - Health and Human Services (HHS)

June 8, 2010: HHS Frequently Asked Questions

May 4, 2010:The White House has released a second fact sheet providing new information addressing the Early Retiree Reinsurance Program. This temporary program will provide reinsurance reimbursement for medical claims for retirees age 55 and older who are not yet eligible for Medicare, and their spouses, surviving spouses, and dependents. Employers who are accepted into the program may receive reimbursement up to 80 percent of claims costs for health benefits between $15,000 and $90,000. All claims incurred between Jan. 1 and June 1 are credited toward the sum for a maximum reimbursement of $15,000, only medical expenses incurred after June 1 are eligible for reimbursement under the program. Both self funded and insured plans can apply, including plans sponsored by state and local governments.

The White House has released a fact sheet providing information for early retirees on the reinsurance program that will be available beginning June 23 of this year. The program will provide $5 billion for temporary financial assistance for employer plans helping employers provide health coverage to their retirees. The program will end on Jan. 1, 2014, when retirees will be eligible to purchase additional coverage through the health insurance exchanges.

Federal Regulations

May 5, 2010: Rules-The Early Retiree Reinsurance Program (A summary of the rule is available in the NCSL Fact Sheet.)