US · guidance
CMS Pub. 100-16, ch. 9, § 10.3
Private Reinsurance Arrangements with Employer/Union Group
Health Plan Sponsors
(Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13)
MA organizations must meet State licensure and financial solvency requirements under 42 CFR
422, Subpart I. With regard to these requirements, all MAOs are permitted to obtain reinsurance
or make other arrangements for the cost of coverage provided to any enrollee (including
1 For further detail on 1876 and 1833 (HCPP) Cost benefit requirements, please see Medicare
Managed Care Manual, Chapter 17 (Cost Based Payment).
arrangements with employers/unions) to the extent that the MAO is at risk for providing the
coverage. (See 42 CFR 423.401(b).) Similarly, Medicare requirements do not prohibit MAOs
offering “800 series” or individual MA plans to employer and union group health plan sponsors
from entering into these kinds of reinsurance arrangements with self-insured (i.e., self-funded)
employers/unions.2 Notwithstanding these arrangements, the MAO retains the responsibility for
meeting all Medicare requirements.
History
(Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5490e12610e653f71887caf3e66f75b9ee675abba9afbd7d1794ae205df11faf
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