For Employers, there are three fees associated with the deployment of Obamacare. What we are finding is that most carriers have these fees and taxes embedded into the rates, so in some cases the employer may not be aware they exist. However, occasionally, you will actually see separate line items on your invoice.
The PCORI Fee affects both fully-insured and self-funded group plans. The fee funds research that evaluates and compares health outcomes, clinical effectiveness, risks and benefits of medical treatments. It is an annual fee that is indexed against medical costs. The fee for plans ending on or after October 1, 2014 and before October 1, 2015 is $2.08 per covered life, a slightly higher PCORI fee than the previous plan year. As in previous years, health insurance carriers will pay the PCORI fee on behalf of fully-insured group health plans. Plan sponsors of self-insured group health plans, including some HRAs and health FSAs, must complete the filing process themselves using IRS Form 720.
Under the Affordable Care Act, group health plans must pay an annual fee to fund the Transitional Reinsurance Program, designed to stabilize premiums in the individual health insurance market from 2014-2016. For 2014, the Transitional Reinsurance Fee is $5.25 per covered life per month and in 2015, the fee drops to $3.67 per member, per month.
The Insurer Fee affects fully insured customers only. The fee will help fund tax subsidies for individuals and families who purchase health insurance through an exchange. Industry sources estimate this fee will be around 3% for 2015.
For more information related to the fee schedule, fee payments and exclusions visit: