Regulations and Guidance
The Early Retiree Reinsurance Program (ERRP) provides reimbursement to sponsors of 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.
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.
Due to the popularity of the program and the rate at which appropriated funds were being distributed to Plan Sponsors, CMS ceased accepting ERRP applications as of May 6, 2011, and will not accept claims incurred after December 31, 2011.
The documents on this page provide information on the following areas: Regulations and General Guidance | Program Compliance | Excluded Code Guidance
Regulations and General Guidance
ERRP Regulations (PDF 132 KB)
Deadline for Submitting Applications (PDF 147 KB) – This notice announces the May 5, 2011 deadline for submitting an ERRP application.
Claims Ineligible for Reimbursement (PDF 24 KB) – This document describes the types of medical items and services that are not covered by Medicare and will not be reimbursed or credited toward the cost threshold under ERRP.
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Incurred Claims Date Limit (PDF 143 KB) – This notice announces that CMS will deny reimbursement requests, in their entirety, that include claims that are incurred after December 31, 2011.
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Explanation of the Appeals Process (PDF 78 KB) – This document provides guidance regarding how a Plan Sponsor can submit a request for appeal of an adverse reimbursement determination, and also provides information about how the appeals process works. Updated 03/27/12
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Timeframe for Using ERRP Funds (PDF 172 KB) – This notice establishes a timeframe by which Plan Sponsors are expected to use ERRP funds.
Program Compliance
Notice to Plan Participants (PDF 81 KB) – This document includes the text of the notice that Plan Sponsors are required to send to plan participants regarding the sponsor’s participation in the ERRP, and provides information about the required timing and manner for sending the notice.
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Allocating Price Concessions (PDF 77 KB) – This document assists Plan Sponsors in reporting post-point of sale price concessions. Updated 12/16/11
Ban on Using ERRP Funds as General Revenue (PDF 116 KB) – This document provides guidance in applying the maintenance of contribution requirement, while also helping to ensure that Plan Sponsors do not violate the prohibition against using ERRP reimbursement as general revenue. Updated 08/19/11
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Reporting Data Inaccuracies (PDF 65KB) – This document discusses the manner and timing for reporting and correcting inaccuracies with previously submitted data. The guidance also describes the process for instances when CMS reopens and revises a reimbursement determination on its own volition or upon request of a Plan Sponsor.
Excluded Code Guidance
CPT-HCPCS Codes
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Procedure Codes Ineligible for Reimbursement (PDF 243 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
ICD-9 Codes
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Additional Ineligible Procedures and Diagnoses (PDF 58 KB) – This document identifies ICD-9 procedure and diagnosis codes which are not acceptable under Medicare. The items and services associated with these codes will not be credited toward the ERRP cost threshold and will not be reimbursed under ERRP. Updated 11/11/11
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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.
ICD-10 Codes
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ERRP Medicare Excluded ICD-10 Codes (CSV File) – This downloadable CSV file contains ICD-10 codes excluded under ERRP.
Revenue Codes
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Revenue Codes Ineligible for Reimbursement (PDF 60 KB) – This document lists the revenue codes for which associated items and services are not reimbursable under ERRP.
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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.
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