The Patient Centered Outcomes Research Fee (PCORI) imposes a fee on health insurers of group policies and self-insured plans, and generally those plan sponsors who offer Health Reimbursement Arrangements (HRAs). The purpose of the fee is to fund research to evaluate and compare the health outcomes and clinical effectiveness, risks, and benefits of medical treatments, services, procedures, and drugs. Since many large multi-employer plans are self-insured, they will need to pay fees ranging from $1-$2 per covered life, depending on the start of the plan year. They must file by July 31, 2013 for the previous plan year ending on or after October 1, 2012 and before October 1, 2019.
Fun(d) Facts
• Based on average number of covered lives,
• $1 per covered life for plan years ending before October 1, 2013,
• $2 per covered life for plan years ending on or after October 1, 2013,
• Indexed based on projected per capita national health expenditures for plan years ending on or after October 1, 2014
IRS Form 720 (Federal Excise Tax Return) is used to report the fee which is due by July 31st of the calendar year immediately following the end of the Plan year (first report is due July 31, 2013 for calendar 2012 plan year ends). Consult your service providers to determine if your plan meets the requirements for compliance since there are some reporting exceptions.
Transitional Reinsurance Program Fees
This fee is designed to help stabilize premiums, for those with pre-existing conditions, in the individual market for the first three years that the Health Exchanges are in effect (2014-2016). It is imposed on self-insured group health plans and insurers of fully-insured group health plans offering medical coverage. Consult your service providers to determine if your plan meets the requirements for compliance since there are some exceptions.
The fee, which is sent to the US Department of Health and Human Services (HHS), will be $63 per covered life for 2014 and is expected to decline for the second and third year. Plans must submit enrollment counts to HHS by November 15 of each applicable year (first enrollment counts will be due November 15, 2014). Within 30 days, HHS will notify the plan of its required contribution amount and expects payment within 30 days of the notification.