There may be some confusion about the term "deductible" as  it is being used in the context of self-insured plans (see below).  Self-insured plans pay the entire claim.  If an individual claim exceeds the attachment point, then the plan is reimbursed by excess reinsurance.  Some in the industry have referred to the amount paid by the plan minus the amount reimbursed by the excess reinsurance as the "deductible" and it does not represent any additional payment or co-payment that should be added by CMS to the total payment, judgment or award.

CMS Mandatory Insurer Reporting

SPECIAL CONSIDERATIONS WHERE LIABILTY SELF-INSURANCE WHICH IS A DEDUCTIBLE OR CO-PAYMENT FOR LIABILTY INSURANCE, NO-FAULT INSURANCE, OR WORKERS’ COMPENSATION IS PAID TO THE INSURER OR WORKERS’ COMPENSATION ENTITY FOR DISTRIBUTION (RATHER THAN DIRECTLY TO THE CLAIMANT):
As indicated in the definition of “liability self-insurance,” such deductibles and co-payments constitute liability self-insurance, and require reporting by the self-insured entities. However, in order to avoid two entities reporting with possible confusion where the deductibles and/or co-payments are physically being paid by the insurer or its TPA, CMS is considering requiring such deductibles and co-payments to be reported as part of the insurer or TPA’s report. CMS specifically seeks comments on this approach. If this approach is not adopted, both entities will have to report in this situation. Regardless of the final decision on this approach, CMS may need to add a few additional data elements (in the form of a question or otherwise) so that it will clearly be able to identify such situations.

Resolution

In response to our article and contact with CMS, CMS has clarified as follows:

Where an entity is self-insured for a deductible but the payment of that deductible is done through the insurer, then the insurer is responsible for including the deductible amount in the amount it reports as a settlement, judgment, award or other payment.