RXDC Survey FAQs

What is a Member?

For the purposes of these instructions, the term “member” means a person who has health coverage, regardless of whether the coverage is associated with an insurance policy, a group health plan, or an FEHB plan. For example, enrollees, dependents, participants, beneficiaries, and FEHB annuitants are all considered members. Retirees and COBRA participants, including their dependents, also are considered members if they are covered by a plan that is not a retiree-only plan.

Should premium paid for coverage of an owner of an S-Corporation or Partnership be counted as amount paid by a member or an amount paid by an employer?

If the owner works for the business and pays their premium out of personal funds, report the premium as an amount paid by a member.

How should I report premium paid for coverage of a sole proprietor or other small business where the coverage only covers the owner and/or the owner’s spouse?

If only the owner and/or the owner’s spouse are covered by a fully-insured policy, you may treat the policy as an individual market policy and you do not have to report whether the amount is paid by a member versus paid by an employer.