When is the cost for a health benefit service provided by a professional (e.g. physician, therapist, nurse practitioner, etc.), incurred for purposes of ERRP?
The ERRP regulation defines “incurred” as “the point in time when the sponsor, health insurance issuer (as defined in 45 CFR 160.103), employment-based plan, plan participant, or a combination of these or similar stakeholders, become responsible for payment of the claim.” 45 C.F.R. ยง 149.2. We interpret this regulatory definition to mean, with respect to the costs associated with a professional service, the date that the service is furnished to the early retiree. For example, if an early retiree is treated by a physician on June 1, 2010, the Date of Service on the claim (i.e. the incurred date) would be June 1, 2010. If a service is rendered over more than one day, the incurred date would be the first date that the service was rendered. For example, if an early retiree is treated by a physician from June 1, 2010 through June 2, 2010, and the Dates of Service on the claim are from June 1, 2010, to June 2, 2010, the incurred date is June 1, 2010.
