§18002 Reinsurance for Early Retirees

Summary

Sets up a temporary reinsurance program to help employer-based health plans pay part of the costs for early retirees and their spouses, survivors, and dependents. The Secretary must start the program no later than 90 days after March 23, 2010, and it runs until January 1, 2014. Health benefits means medical, hospital, prescription drug, and similar care. An employment-based plan means a group health plan run by employers, unions, or multiemployer groups that covers early retirees. Early retirees are people age 55 or older who are not yet eligible for Medicare and who are not current workers who get health coverage from the employer. Plans must apply and be certified to join. To qualify, a plan must work to lower costs for people with long-term or expensive conditions and must give proof of actual claim costs. Plans file claims showing what they really spent, including member deductibles, co-pays, and any discounts or rebates. The government pays 80 percent of the part of a claim that is over $15,000, as long as the claim is at least $15,000 and no more than $90,000 (those dollar limits are adjusted each year by the percent change in the Medical Care Component of the Consumer Price Index for All Urban Consumers, rounded to the nearest $1,000). Money paid must be used to lower premiums or out-of-pocket costs for the plan or its members, not as general revenue. Payments are not counted as taxable income for the employer groups. The Secretary will set up an appeals process, anti-fraud rules, and will audit claims every year. Congress made $5,000,000,000 available for the program, and the Secretary can stop taking applications if funds run out.