Centers for Medicare and Medicaid Services (CMS) are considering how self-insured employers are going to be required to report liability, no-fault or workers compensation cases for employers participating in Captives and other Multi-Employer Welfare Arrangements (MEWAs)..

In written guidance, CMS has designated the Responsible Reporting Entity for Group Health Plan coverage as the self-insured (captive) plan's administrator or fiduciary.  CMS in writing designates the RRE for liability in the same fashion, although they have made comments in teleconferences that seem to indicate they may hold the individual employer responsible instead.  CMS clearly states that the RRE for workers' compensation is the the employer.

During a recent CMS Town Hall meeting, a participant asked if each employer of a captive was required to report and CMS responded in the affimative, but agreed to take the matter under consideration.

Resolution

In response to our article and contact with CMS, CMS has clarified which entity is the RRE given in summary below.

The fiduciary of Single Employer Welfare Arrangements and  Multi-Employer Welfare Arrangments (e.g., captives) are responsible for reporting.  For example, a Captive Insurer may report for all of their participating employers and may use an TPA or Agent as their vehicle for reporting.

No-Fault encompasses automobile, homeowners and commercial plans.

Although "no-fault" insurance is generally used to describe any auto insurance system that both requires drivers to carry insurance for their own protection and places limitations on their ability to sue other drivers for damages; in its broadest sense, "no-fault" insurance is any type of insurance contract under which insureds are indemnified for losses by their own insurance company.

According to CMS, the definition of no-fault insurance found at 42 C.F.R. 411.50 is controlling: No-fault insurance means insurance that pays for medical expenses for injuries sustained on the property or premises of the insured, or in the use, occupancy, or operation of an automobile, regardless of who may have been responsible for causing the accident. This insurance includes but is not limited to automobile, homeowners, and commercial plans. It is sometimes called “medical payments coverage”, “personal injury protection”, or “medical expense coverage.

Many types of automobile insurance are included.

Under that definition, among other types of insurance, the following automobile insurance must be reported by insurers:

  • Uninsured Motorist Bodily Injury (UM)
  • Underinsured Motorist Bodily Injury (UNDUM)
  • Personal Injury Protection (PIP)
  • First Party Benefits (FPB)
  • Medical Payments (Med Pay)
  • Accidental Medical Protection Plan (AMPP)
  • Accidental Death Benefit (ADB or ADD)

No-Fault Associated with Liability Insurance

CMS Mandatory Insurer Reporting also requires insurers to report no-fault insurance that is associated with liability insurance.