Health Care Reform Update: Many Self-Insured Plans Subject to New Annual Fees This Year

New regulations have been issued under the Patient Protection and Affordable Care Act (“PPACA”) implementing annual fees and reporting requirements on self-insured health plans and indirectly on fully insured plans. The Internal Revenue Service (“IRS”) has finalized regulations on annual fees imposed on sponsors of self-insured plans and issuers of health insurance policies to fund the Patient-Centered Outcomes Research Trust Fund. The fee for 2013 is $1 per covered life, which must be reported and paid by July 31, 2013 for calendar-year plans. The Department of Health and Human Services (“HHS”) has issued proposed regulations that would impose additional fees on self-insured plans and health insurance issuers to fund the Transitional Reinsurance Program. HHS estimates that the initial annual contribution rate, for 2014, will be $63 per covered life.

PPACA established the Patient-Centered Outcomes Research Institute (“PCORI”) to synthesize and disseminate research relating to the comparative clinical effectiveness of various medical treatments. PCORI is to be funded in part by fees (“PCORI fees”) assessed on sponsors of self-insured health plans and issuers of health insurance policies.

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