Which Early Retirees must be included in the ERRP Early Retiree List?
After the Plan Sponsor has identified its early retirees (Subscribers), a second condition must be present for an individual to be included in the ERRP Early Retiree list. The individual (i.e. the Subscriber and/or Member) must have accumulated $15,000 or more in plan and/or early retiree paid claim amounts for health benefits during the plan year, which are eligible for credit towards the ERRP cost threshold or ERRP reimbursement. Accrual of eligible claims occurs on an individual basis. Therefore, a Subscriber’s claims accrue for the Subscriber. A Member’s claims accrue for the individual Member. In order for a claim for a specific medical item or service to count towards the cost threshold, it must meet all of the following conditions. It must be: • A medical item or service that is not excluded for reimbursement by Medicare; • Incurred within the plan year (For plan years that start before and end after June 1, 2010, claims incurred between the start of the plan year and May 31, 20
After the Plan Sponsor has identified its early retirees (Subscribers), a second condition must be present for an individual to be included in the ERRP Early Retiree list. The individual (i.e. the Subscriber and/or Member) must have accumulated an amount of plan and/or early retiree paid claims for health benefits during the plan year, of at least the applicable cost threshold for that plan year (review Common Question H200-25 for plan year specific cost threshold and cost limit amounts), which are eligible for credit towards the ERRP cost threshold or ERRP reimbursement. Accrual of eligible claims occurs on an individual basis. Therefore, a Subscriber’s claims accrue for the Subscriber. A Member’s claims accrue for the individual Member. In order for a claim for a specific medical item or service to count towards the cost threshold, it must meet all of the following conditions. It must be: • A medical item or service that is not excluded for reimbursement by Medicare; • Incurred withi
