Consolidated Appropriations Act (CAA) FAQ

Accident & Health

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The Consolidated Appropriations Act, 2021(CAA) was signed into law on December 27, 2020, and provides over $2.3 trillion in funding, including $900 billion for COVID-19 relief. The CAA has since been amended and renamed for subsequent  fiscal years, 2022 and 2023 respectively. 

There are several components of the Act that apply to the healthcare industry separate from the COVID-19 pandemic. One such section, the "No Surprises Act", went into effect in January 2022.  The No Surprises Act protects patients from surprise medical bills and balance billing when they seek and/or receive care out-of-network, and establishes an Independent Dispute Resolution (IDR) process designed to resolve disagreements between providers and insurers over appropriate rates of reimbursement for out-of- network services.  Additionally, section 202 of the Act requires disclosure of fees for brokerage and consulting services.

FAQs

The CAA sets forth new compensation disclosure requirements that apply to brokers and consultants with respect to both fully-insured and self-funded health plans. Do these requirements apply to Swiss Re Corporate Solutions ("Swiss Re")?

In providing medical stop loss coverage to a self-insured employer, Swiss Re, in its capacity as insurance carrier (Swiss Re Corporate Solutions America Insurance Corporation), is not subject to the transparency provisions of the CAA.

Swiss Re is not a "covered service provider" under the CAA, which is defined as a service provider that enters into a contract with a covered plan in connection with providing one or more of the following services:

  • brokerage services, provided to a covered plan with respect to stop-loss insurance, or
  • consulting, related to the implementation of stop-loss insurance.

Swiss Re does not offer brokerage or consulting services to its Policyholders, and is therefore, not a service provider under the CAA, and subsequently, is not subject to the CAA compensation disclosure requirements.

What is Swiss Re's policy for coverage of claims that may extend beyond the benefit period due to an active independent dispute resolution (IDR) process that has not been resolved?

In the event the group is required to pay a claim outside the Benefit Period due to the IDR process, such claim will be deemed Paid on the date the original denial or Payment is made, and eligible for reimbursement under the Policy, subject to all its terms, conditions, limitations, and exclusions.

For a claim to be reimbursable:

  • the denial or Payment must be made before the paid Benefit Period expires;
  • we must be notified in writing before the end of the paid Benefit Period that the IDR may result in a Claim under the Policy; and
  • the claim must be Paid within 30 days following the IDR determination.

As part of the IDR process, both entities must pay an administrative fee and the losing party must pay an arbitration fee. Will Swiss Re reimburse these fees under the stop loss Policy?

Swiss Re will reimburse the Policyholder for administrative fees for the federal IDR process up to three hundred fifty dollars ($350.00), in accordance with current guidelines from the Departments of Health and Human Services (HHS), Labor and the Treasury.

Will Swiss Re reimburse fees charged to calculate a qualifying payment amount (QPA)?

The qualifying payment amount (QPA) is the Plan's average or median rate for services (adjusted for inflation) under the NSA. The QPA helps to limit cost-sharing for both emergency and non-emergency services provided by an out-of-network Provider in an in-network facility.

Effective immediately, any Claims with QPA fees that were/are submitted to Us on or after November 15, 2023, will be eligible for reimbursement provided that TPAs utilized their standard out-of-network pricing methodologies to calculate the QPA. 

Please contact your regional Business Development Manager if you have any questions.

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