Producer Service Fee CMS guidance for Small Group 1-100 new business and renewals in Pennsylvania and Delaware

On May 27, 2015, CMS issued CCIIO Technical Guidance (CCIIO 2015—0001): Questions and Answers Regarding the Medical Loss Ratio (MLR) Reporting and Rebate Requirements. To quote in part: “The purpose of this bulletin is to provide guidance regarding: the limited circumstances in which a health insurance issuer may, for MLR reporting purposes, exclude agent and broker fees or commissions from earned premium under 45 CFR §158.130. . . ”

We are still interpreting this guidance, but it raises questions that we’re in the process of working through. Rather than asking you and your clients to wait while we evaluate the effect of the new guidance in numerous states, we’re making a proactive decision to address the issue. Starting with January 1, 2016 effective dates, we will begin to revert from Producer Service Fee (PSF) to commission for Small Group new business and renewals. This decision only applies to Small Group (1-100) and does not impact our PSF strategy in other segments. No Small Group plan sponsor should be on PSF after December 1, 2016. Revised commission schedules are being developed and you will be alerted when they become available.

We’re making every effort to be thoughtful as we navigate this new course. Our mission is to be mindful of your time, your effort, and your financial investment. As we continue to work within this guidance, we will communicate with you and do our best to keep you informed.


If you have additional questions, please contact your local Aetna representative.

Thank you.