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Pension Resource

Treas. Reg. § 54.9825-5T

Aggregate reporting (temporary).
eCFR editorial change effective 2021-12-23 · current · last amended by T.D. 9958, 86 FR 66696, Nov. 23, 2021
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(a) General requirement. A group health plan or a health insurance issuer offering group health insurance coverage must submit, or arrange to be submitted, the information required in § 54.9825-6T(b) separately for each State in which group health coverage or group health insurance coverage was provided in connection with the group health plan or by the health insurance issuer. The report must include the experience of all plans and policies in the State during the reference year covered by the report, and must include the experience separately for each market segment as defined in § 54.9825-3T.
(b) Aggregation by reporting entity
(1) In general. If a reporting entity submits data on behalf of more than one group health plan in a State and market segment, the reporting entity may aggregate the data required in § 54.9825-6T(b) for the group health plans for each market segment in the State.
(2) Multiple reporting entities.
(i) If multiple reporting entities submit the required data related to one or more plans or issuers in a State and market segment, the data submitted by each of these reporting entities must not be aggregated at a less granular level than the aggregation level used by the reporting entity that submits the data on total annual spending on health care services, as required by § 54.9825-6T(b)(4), on behalf of these plans or issuers.
(ii) The Secretary, jointly with the Secretary of Health and Human Services and the Secretary of Labor, may specify in guidance alternative or additional aggregation methods for data submitted by multiple reporting entities, to ensure a balance between compliance burdens and a data aggregation level that facilitates the development of the biannual public report required under section 9825(b) of the Code.
(3) Group health insurance coverage with dual contracts. If a group health plan involves health insurance coverage obtained from two affiliated issuers, one providing in-network coverage only and the second providing out-of-network coverage only, the plan's out-of-network experience may be treated as if it were all related to the contract provided by the in-network issuer.
(c) Aggregation by State.
(1) Experience with respect to each fully-insured policy must be included on the report for the State where the contract was issued, except as specified in paragraphs (c)(3) and (4) of this section.
(2) Experience with respect to each self-funded group health plan must be included on the report for the State where the plan sponsor has its principal place of business.
(3) For individual market business sold through an association, experience must be attributed to the issue State of the certificate of coverage.
(4) For health coverage provided to plans through a group trust or multiple employer welfare arrangement, the experience must be included in the report for the State where the employer (if the plan is sponsored at the individual employer level) or the association (if the association qualifies as an employer under ERISA section 3(5)) has its principal place of business or the state where the association is incorporated, in the case of an association with no principal place of business.
(d) Applicability date. The provisions of this section are applicable beginning December 27, 2021.
Source credit, amendments & notes

[T.D. 9958, 86 FR 66696, Nov. 23, 2021]

Treas. Reg. § 54.9825-5T — Aggregate reporting (temporary). · eCFR editorial change effective 2021-12-23 · https://pensionresource.website/EAMain?content=EAMain.Law&id=cfr26-54.9825-5T&asof=2021-12-23 · printed Oct 16, 2026
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  • (a) General requirement.
  • (b) Aggregation by reporting entity
  • (c) Aggregation by State.
  • (d) Applicability date.
Guidance addressing this section

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Also cited in 3 other documents
IRS / Treasury
Treasury Decisions
  • T.D. 9958 Dec 6, 2021 — This document sets forth temporary regulations implementing certain transparency requirements under section 204 of Division BB of Title II of the Consolidated … (a)(b)(b)(1)(b)(2)(i)(b)(3)(c)
Proposed Rules
  • 86 FR 66495Proposed Nov 23, 2021 — Prescription Drug and Health Care Spending Comments due Jan 24, 2022
Final Rules

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Nov 23, 2021Dec 22, 2021eCFR amendment effective 2021-11-23 run 6View
Dec 23, 2021currenteCFR editorial change effective 2021-12-23 run 6T.D. 9958, 86 FR 66696, Nov. 23, 2021View · Redline (sign in)
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