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CMS Releases New FAQs on QHP Premiums Paid by Third Parties

The Centers for Medicare & Medicaid Services (CMS) released Feb. 7 frequently asked questions (FAQs) related to premium payments paid by third parties for qualified health plans (QHPs) sold through the health insurance marketplaces (exchanges). These FAQs further clarify the Nov. 4, 2013 FAQ, which stated that the U.S. Department of Health and Human Services (HHS) encourages issuers to reject premium payments from third parties such as hospitals, other health care providers, and other commercial entities. The Feb. 7 FAQs clarify that the Nov. 4 FAQ does not apply to premium and cost-sharing payments made on behalf of QHP enrollees if: (1) the payments are made by Indian tribes, tribal organizations, urban Indian organizations, or state and federal government programs or grantees, or (2) the payments are made by a private, nonprofit foundation on behalf of QHP enrollees who meet criteria based on financial status and not health status. In the second situation, CMS said that it expects premium and cost-sharing payments to cover the entire policy year.


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