HOW SHOULD A HEALTH PLAN DETERMINE WHAT RECEIPTS TO USE TO DECIDE WHETHER IT QUALIFIES AS A SMALL HEALTH PLAN?
A. A small health plan is defined at 45 C.F.R.§ 160.103 as “a health plan with annual receipts of $5million or less.” Health plans that report receipts to the IRS on identified tax forms. Health plans that file certain federal tax returns and report receipts on those returns should use the guidance provided by the Small Business Administration at 13 C.F.R. § 121.104 to calculate annual receipts. Health plans that do not report receipts to the IRS for example, ERISA group health plans that are exempt from filing income tax returns should use proxy measures to determine their annual receipts. Fully insured health plans should use the amount of total premiums which they paid for health insurance benefits during the plan’s last full fiscal year. Self-insured plans, both funded and unfunded, should use the total amount paid for health care claims by the employer, plan sponsor or benefit fund, as applicable to their circumstances, on behalf of the plan during the plan’s last full fiscal year
