Frequently Asked Questions

Are There Any Exceptions to the MSP Reporting Requirements?

Yes. There are three exceptions in which a group health plan may not be required to report information to CMS.

1. Individuals with Retiree Coverage: Former employees and their family members who are participating in a group health plan generally will not be subject to the MSP reporting requirements. This is because such former employees are not considered to have coverage by virtue of current employment status.

2. Employers with Fewer Than 20 Employees: The MSP reporting requirements only apply to those group health plans with 20 or more employees for each working day in at least 20 weeks in either the current or the preceding calendar year. If an employer has a workforce that is close to the threshold, this requires constant monitoring to ensure the employer does not exceed the threshold. For multiemployer or multiple employer plans, if at least one of the employers in the plan has 20 or more employees, then the group health plan will be subject to the MSP reporting requirements.

3. HRA Coverage of Less Than $5,000 Annually: CMS has provided an MSP reporting requirement exemption for HRAs based on their annual benefit amount. HRA coverage does not have to be reported if its annual benefit is less than $5,000.