The Center for Consumer Information and Insurance Oversight

Transitional Reinsurance Program Payment Audits

Section 1341 of the Patient Protection and Affordable Care Act (ACA) established the transitional reinsurance program to stabilize premiums in t he individual market inside and outside of the Exchanges in each State and the District of Columbia for benefit years 2014, 2015, and 2016. The transitional reinsurance program collected contributions from contributing entities to fund reinsurance payments to issuers of non-grandfathered individual market reinsurance-eligible plans, the administrative costs of operating the program, and the General Fund of the U.S. Treasury. The Department of Health and Human Services (HHS) operated the program, and the transitional reinsurance program on behalf of any state that elected not to operate its own program. For benefit years 2014 and most of benefit year 2015, HHS operated the transitional reinsurance program in all states and the District of Columbia with exception of Connecticut. Effective April 7, 2017, HHS began operating the transitional RI programs in Connecticut for remainder of benefit year 2015. For benefit year 2016, HHS operated the transitional reinsurance program in all states and the District of Columbia.

45 CFR § 153.410(d) authorizes HHS or its designee to audit or conduct a compliance review of an issuer with reinsurance-eligible plans to assess compliance with applicable federal requirements related to the transitional reinsurance program.

Transitional Reinsurance Program  Payment Audit Reports

The transitional reinsurance program payment audits commenced in 2018 with the review of data submitted by issuers of reinsurance eligible plans to their respective EDGE servers to calculate reinsurance payments for benefit year 2014. This page contains the Transitional Reinsurance Program Payment  audit reports and is organized in alphabetical order by audit benefit year. Reports will be uploaded as each audit benefit year is completed.

Transitional Reinsurance Program Payment Audit Reports by Reporting Year:

Benefit Year 2014

• Aetna Health Inc. (a PA corp.)
• Aetna Life Insurance Company
• Aetna Life Insurance Company
• Aetna Life Insurance Company (a PA corp.)
• AmeriHealth HMO, Inc
• AultCare Insurance Company
• Blue Cross and Blue Shield of North Carolina
• Blue Cross Blue Shield of Oklahoma
• Blue Cross Blue Shield of Texas
• Blue Cross Blue Shield of Western New York
• Blue Cross of California (Anthem BC)
• Blue Shield of California
• Boston Medical Center Health Plan, Inc.
• BridgeSpan Health Company
• Buckeye Community Health Plan
• Capital District Health Plan (DPHP)
• CareFirst Blue Choice, Inc.
• Cigna Health and Life Insurance Company of Colorado
• Cigna Health and Life Insurance Company of Florida
• Colorado Choice Health Plans
• Community Health Plan of Washington
• Contra Costa Health Plan
• Coventry Health Care of Delaware, Inc.
• Coventry Health Care of Florida, Inc.
• Fallon Community Health Plan, Inc.
• Geisinger Health Plan
• GlobalHealth, Inc.
• Health Net Life Insurance Company
• Healthfirst PHSP, Inc.
• Health Tradition Health Plan
• Highmark Health Insurance Company
• HMO Colorado Inc. dba HMO NV (Anthem BCBS)
• HMO Colorado Inc. (Anthem BCBS)
• Horizon Healthcare Services, Inc.
• Humana Employers Health Plan of Georgia, Inc.
• Humana Insurance Company
• Humana Medical Plan, Inc.
• Humana Medical Plan of Utah, Inc.
• Independent Health benefits Corporation
• Kaiser Foundation Health Plan, Inc.
• Kaiser Foundation Health Plan, Inc.
• LifeWise Health Plan of Washington
• Local Initiative Health Authority for Los Angeles County
• Moda Health Plan, Inc.
• Molina Healthcare of Washington, Inc.
• New Health Ventures Inc.
• New Mexico Health Connections
• New York States Catholic Health Plan, Inc.
• Oscar Insurance Corporation
• Oxford Health Plans (NY), Inc.
• Paramount Insurance Company
• Peach State Health Plan
• QualChoice Health Plan, Inc. (QCA)
• Quartz Health Plan Corporation (formerly Gundersen Lutheran Health Plan)
• Rocky Mountain Health Plans
• Sharp Health Plan
• Summa Insurance Company, Inc.
• Time Insurance Company
• Western Health Advantage