How will the Patient Centered Outcomes Research Institute fee be paid?
The Patient Centered Outcomes Research Institute (PCORI) fee is $1 per covered life on plan years ending after September 30, 2012. The fee increases to $2 per covered life for plan years ending Oct. 1, 2013, through Sept. 14, 2014.
BCBSNE will pay the PCORI fee and include it as part of the premium for fully insured businesses. For self-funded businesses, the fee is to be paid by the plan sponsor and treated like an excise tax by the employer group.
What form do self-insured employers need to file to report the Patient Centered Outcomes Research Fee (or Comparative Effectiveness Research Fee)?
IRS form 720, which is titled Quarterly Federal Excise Tax Return, is the form used for the PCORI filing. There is a specific line on the form for reporting the PCORI fee.
The form can be located at: http://www.irs.gov/pub/irs-pdf/f720.pdf.
How will the Transitional Reinsurance fee be paid?
Fully-insured and self-insured businesses will pay approximately $60 per covered life per year. BCBSNE will itemize that fee on bills for self-funded business, with the first inclusion on the bill in December 2014. BCBSNE has not determined how the fee will be itemized for fully insured business.
If a client had a renewal/plan year on 1/1/2013, they would have to file the $1 Patient Centered Outcomes Research fee by July 31, 2013 utilizing the enrollment in 2012, correct?
Correct. The $1 fee per covered life would need to be reported and paid by 7/31/2013, and they would use the enrollment from the year in which they are reporting—so the figure from the 2012 plan year would be used.
The Patient Centered Outcomes Research Institute Fee applies to fully insured and self-funded plans and is the earliest of the new fees and taxes under the ACA. The fee increases to $2 per member per year in the second year (paid by July 31, 2014). Then, the fee adjusts based on the percentage increase in the projected per capita amount of national health expenditures.
Do all of the Affordable Care Act taxes and fees apply to both grandfathered and non-grandfathered employer groups?
The following taxes and fees apply to both: Transitional Reinsurance Fee, Health Insurance Industry Fee, Patient-Centered Outcome Research Fee, Tax on High-Cost Insurance plans (i.e. Cadillac Tax) However, the Risk Adjustment Fee applies only to non-grandfathered groups.
Does the Transitional Reinsurance Fee take the place of an employer buying stop-loss insurance?
No. This is a temporary fee that will diminish each year over its three-year requirement that supports the transition of individual and small group business to the Exchange (also called Marketplace).