Code of Federal Regulations (Last Updated: July 5, 2024) |
Title 45 - Public Welfare |
Subtitle A - Department of Health and Human Services |
SubChapter B - Requirements Relating to Health Care Access |
Part 149 - Requirements for the Early Retiree Reinsurance Program |
Subpart E - Reimbursement Methods |
§ 149.320 - Universe of claims that must be submitted.
Latest version.
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§ 149.320 Universe of claims that must be submitted.
(a) Claims submitted for an early retiree, as defined in § 149.2, must include claims below the applicable cost threshold for the plan year.
(b) Claims must not be submitted until claims are submitted for amounts that exceed the applicable cost threshold for the plan year for the early retiree.
(c) Sponsors must not submit claims for health benefits for an early retiree to the extent the sponsor has already submitted claims for the early retiree that total more than the applicable cost limit for the applicable plan year.