Fees at A Glance

ACA News Update

Dear Vensure Client:

We wanted to take a moment to make sure you understand the details of the mandatory ACA fees for employers.

Associated with the new ACA compliant plans, there are a couple of mandatory fees (TRF and PCORI fees) which are deemed the responsibility of the Employer. The determination of which fee(s) may apply will depend upon employee utilization.

Embedded in the Patient Protection and Affordable Care Act (ACA), you will find the PCORI fee, which is explained below:

FEE AT A GLANCE

Patient – Centered Outcomes Research Institute(PCORI) Fee:
A fee placed upon issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans that helps to fund the Patient-Centered Outcomes Research Institute (PCORI). The institute will assist through research, patients, clinicians, purchasers and policy-makers in making informed health decisions by advancing the quality and relevance of evidence-based medicine. The institute will compile and distribute comparative clinical effectiveness research findings.

The PCORI fee is attached to both the Minimal Essential Coverage (MEC) plan and MV plan, and is $2.08 in 2015. This fee is not applicable to the indemnity plan if your employees elect this coverage.

Another fee that is only tied to the MV plan is the Transitional Reinsurance Program Contribution Fee(TRF). Under the (ACA), your group health plan is also required to pay the TRF on plan years from 2014 – 2016. This fee is paid to the government directly by you and is in addition to, the PatientCentered Outcomes Research Institute (PCORI) fee that began for plan years that ended in 2012(continuing until 2019). See explanation below.

FEE AT A GLANCE

Transitional Reinsurance Program Contribution(TRF) Fee:
A fee to help stabilize premiums for coverage in the individual market during the years 2014 – 2016. The statute requires all health insurance issuers and third-party administrators on behalf of self-insured group health plans to make contributions under this program to support payments to individual market issuers that cover high-cost individuals. Regulations proposed by the Department of Health and Human Services to implement the Reinsurance Program specify that self-insured group health plans are liable for the contributions, although a plan may utilize a third-party administrator or administrative-servicesonly(ASO) contractor for transfer of the contributions.

This fee is $44.00 per employee in 2015. This fee is not applicable to the MEC Plan or the Indemnity Plan.

Both the PCORI and the TRF will be pro-rated throughout the year to match your company’s deduction schedule. Detailed information on how these fees are billed will be in next week’s ACA News Update, issued on February 3, 2015.

NEXT WEEK’S TOPICS

  • How the PCORI/TRF fees are billed
  • Premium billing options

CONTACTS

  • Ryan Scott – ryan.scott@vensure.com
  • Anna Hoebing – anna.hoebing@vensure.com

CONTACTS

  • Ryan Scott – ryan.scott@vensure.com
  • Anna Hoebing – anna.hoebing@vensure.com

FUN FACTS

We know that ACA is not the most interesting of subjects, so with that being said, we thought we would end with a few facts that we DO find interesting!

  • In 1972, a group of scientists reported that you could cure the common cold by freezing the big toe.
  • The human brain cell can hold five-times as much information as the Encyclopedia Britannica.