US · guidance
CMS Pub. 100-18, ch. 12, § 10.5
Private Reinsurance Arrangements with Employer/Union Group Health Plan Sponsors
PDP sponsors must meet Part D state licensure and financial solvency requirements under 42
CFR 423.401. With regard to these requirements, all PDP sponsors are permitted to obtain
reinsurance or make other arrangements for the cost of coverage provided to any enrollee
(including arrangements with employers/unions) to the extent that the PDP sponsor is at risk
for providing the coverage. See 42 CFR 423.401(b). Similarly, Part D requirements do not
prohibit PDP sponsors offering “800 series” or individual PDPs 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 PDP
sponsor retains the responsibility for meeting all Part D requirements.
History
(Rev.6, Issued: 11-07-08, Effective/Implementation: 11-07-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
f67d80c6471e44b413fe60101f4b1f607a5fdbb6fe238ecc48954f24e2542fb3
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