Voglio sapere a riguardo di…

Federal Register / Vol. 86, No. 85 / Wednesday, May 5, 2021 / Rules and Regulations HHS, in the timeframe and manner established by HHS, equal to the product of the sum of the monthly user fee rate specified in the annual HHS
notice of benefit and payment parameters for State Exchanges on the Federal platform for the applicable benefit year, multiplied by the monthly premium charged by the issuer for each policy under the plan where enrollment is through the State-based Exchange on the Federal platform.
3 A participating issuer offering a plan through an State-based Exchange on the Federal platform that has adopted the Direct Enrollment option or Federally-facilitated Exchange that has adopted the direct enrollment option as described in 155.221j of this subchapter, as specified in a Federal agreement with HHS, must remit a user fee to HHS each month, in the timeframe and manner established by HHS, equal to the product of the monthly user fee rate for the applicable benefit year specified in an annual HHS
notice of benefit and payment parameters published in advance of the applicable benefit year and the monthly premium charged by the issuer for each policy under the plan where enrollment is through the State-based Exchange on the Federal platform that has adopted the Direct Enrollment option or Federally-facilitated Exchange that has adopted the direct enrollment option.
d Adjustment of Exchange user fees.
1 A participating issuer offering a plan through a Federally-facilitated Exchange or State Exchange on the Federal platform may qualify for an adjustment of the Federally-facilitated Exchange user fee specified in paragraph c1 of this section, the State Exchange on the Federal platform user fee specified in paragraph c2 of this section, or the user fee specified in paragraph c3 of this section, applicable to issuers participating in a State Exchange on the Federal platform or a Federallyfacilitated Exchange that has adopted the direct enrollment option under 155.221j of this subchapter, the extent that the participating issuer

2 For a participating issuer described in paragraph d1 of this section to receive an adjustment of a user fee under this section i
A Identifying information for the participating issuer and each third party administrator that received a copy of the self-certification referenced in 26 CFR
54.98152713Aa4 or 29 CFR
2590.7152713Aa4 with respect to which the participating issuer seeks an adjustment of the user fee specified in
VerDate Sep<11>2014

22:49 May 04, 2021

Jkt 253001

paragraph c1, 2, or 3 of this section, as applicable, whether or not the participating issuer was the entity that made the payments for contraceptive services;
B Identifying information for each self-insured group health plan with respect to which a copy of the selfcertification referenced in 26 CFR
54.98152713Aa4 or 29 CFR
2590.7152713Aa4 was received by a third party administrator and with respect to which the participating issuer seeks an adjustment of the user fee specified in paragraph c1, 2, or 3
of this section, as applicable; and

ii Each third party administrator that intends to seek an adjustment on behalf of a participating issuer of the Federallyfacilitated Exchange user fee, the Statebased Exchange on the Federal platform user fee, or the user fee applicable to issuers participating in a State-based Exchange on the Federal platform or a Federally-facilitated Exchange that has adopted the direct enrollment option 155.221j of this subchapter based on payments for contraceptive services, must submit to HHS a notification of such intent, in a manner specified by HHS, by the 60th calendar day following the date on which the third party administrator receives the applicable copy of the self-certification referenced in 26 CFR 54.9815
2713Aa4 or 29 CFR 2590.715
2713Aa4.
iii
B Identifying information for each self-insured group health plan with respect to which a copy of the selfcertification referenced in 26 CFR
54.98152713Aa4 or 29 CFR
2590.7152713Aa4 was received by the third party administrator and with respect to which the participating issuer seeks an adjustment of the user fee specified in paragraph c1, 2, or 3
of this section, as applicable;

3 If the requirements set forth in paragraph d2 of this section are met, the participating issuer will be provided a reduction in its obligation to pay the user fee specified in paragraph c1, 2, or 3 of this section, as applicable, equal in value to the sum of the following:

4 If the amount of the adjustment under paragraph d3 of this section is greater than the amount of the participating issuers obligation to pay the user fee specified in paragraph c1, 2, or 3 of this section, as applicable, in a particular month, the participating issuer will be provided a
PO 00000

Frm 00153

Fmt 4701

Sfmt 4700

24291

credit in succeeding months in the amount of the excess.
5 Within 60 days of receipt of any adjustment of a user fee under this section, a participating issuer must pay each third party administrator with respect to which it received any portion of such adjustment an amount that is no less than the portion of the adjustment attributable to the total dollar amount of the payments for contraceptive services submitted by the third party administrator, as described in paragraph d2iiiD of this section. No such payment is required with respect to the allowance for administrative costs and margin described in paragraph d3ii of this section. This paragraph does not apply if the participating issuer made the payments for contraceptive services on behalf of the third party administrator, as described in paragraph d1i of this section, or is in the same issuer group as the third party administrator.
6 A participating issuer that receives an adjustment in the user fee specified in paragraph c1, 2, or 3 of this section for a particular calendar year must maintain for 10 years following that year, and make available upon request to HHS, the Office of the Inspector General, the Comptroller General, and their designees, documentation demonstrating that it timely paid each third party administrator with respect to which it received any such adjustment any amount required to be paid to the third party administrator under paragraph d5 of this section.
7 A third party administrator of a plan with respect to which an adjustment of the user fee specified in paragraph c1, 2, or 3 of this section is received under this section for a particular calendar year must maintain for 10 years following that year, and make available upon request to HHS, the Office of the Inspector General, the Comptroller General, and their designees, all of the following documentation:

32. Section 156.130 is amended by revising paragraph e to read as follows:
156.130

Cost-sharing requirements.

e Premium adjustment percentage.
The premium adjustment percentage is the percentage if any by which the average per capita premium for health insurance coverage for the preceding calendar year exceeds such average per capita premium for health insurance for 2013. HHS may publish the annual premium adjustment percentage in
E:FRFM05MYR2.SGM

05MYR2