Regulations and Guidance

The Early Retiree Reinsurance Program (ERRP) provides reimbursement to participating employment-based plans for a portion of the costs of health benefits for early retirees and early retirees’ spouses, surviving spouses, and dependents. The program was authorized in the Affordable Care Act.

The ERRP was established in the Affordable Care Act. Congress appropriated funding of $5 billion for this temporary program, which became effective June 1, 2010, under interim final rules published by the Department on May 5, 2010. The program ends no later than January 1, 2014. The program provides reimbursement to sponsors of participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses, and dependents. The Secretary will reimburse sponsors for certain claims between $15,000 and $90,000 (with those amounts being indexed for plan years starting on or after October 1, 2011). The purpose of the reimbursement is to make health benefits more affordable for plan participants and sponsors so that health benefits are accessible to more Americans than they would otherwise be without this program.

Links to resources about ERRP regulations and guidance are provided below.

• Fact Sheet (PDF 48 KB): This fact sheet provides information about the purpose of the program, what employers need to do in order to access reimbursement,
  and more.

• ERRP Regulations

• Notice to Plan Participants (PDF 81 KB)

• Claims Ineligible for Reimbursement (PDF 24 KB)

• Procedure Codes Ineligible for Reimbursement (PDF 576 KB): This document contains a detailed listing of Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes that represent items and services that are excluded from reimbursement under the ERRP, and that will not count toward the ERRP cost threshold or cost limit. Updated 07/18/11

• ERRP Medicare Excluded CPT-HCPCS Codes (CSV File): This downloadable CSV file includes all of the referenced excluded CPT and HCPCS codes contained in Procedure Codes Ineligible for Reimbursement. Updated 07/18/11

• Additional Ineligible Procedures and Diagnoses (PDF 58 KB)  Updated 11/11/11

• ERRP Medicare Excluded ICD-9 Codes (CSV File): This downloadable CSV file includes all of the referenced excluded ICD-9 codes contained in Additional Ineligible Procedures and Diagnoses.

• ERRP Medicare Excluded ICD-10 Codes (CSV File)

• Revenue Codes Ineligible for Reimbursement (PDF 60 KB)

• ERRP Medicare Excluded Revenue Codes (CSV File): This downloadable CSV file includes all of the referenced excluded revenue codes contained in Revenue Codes Ineligible for Reimbursement.

• Allocating Price Concessions (PDF 77 KB) Updated 12/16/11

• Ban on Using ERRP Funds as General Revenue (PDF 116 KB) Updated 08/19/11

• Explanation of the Appeals Process (PDF 106 KB)

• Reporting Data Inaccuracies (PDF 65KB)

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