What if I don’t know the amount of premium paid by members versus employers?

Section 204 of the CAA, and the Prescription Drug and Health Care Spending interim final rules (86 FR 66662) require premium information to be reported separately according to amounts paid by members and amounts paid by employers. Generally, if you are reporting on behalf of a group health plan or FEHB plan, you must obtain this information from the plan.

If you are unable to obtain all necessary information to calculate average monthly premium paid by members and average monthly premium paid by employers from a plan, you should:

• Exclude the plan when calculating average monthly premium paid by members and average monthly premium paid by employers in columns E and F.
• Include the plan when calculating life years, earned premium, premium equivalents, admin fees, and stop-loss premium in columns G–K.