Fees Under the New Healthcare Reform Act Set to Begin

The new healthcare reform law includes a number of new taxes and fees which are rarely mentioned by the law’s supporters. On December 5, the IRS announced final regulations governing new fees on health insurers and employer sponsors of self-insured health plans, designed to fund the “Patient Centered Outcomes Research Trust”. This Trust finances an “Institute” tasked with “advancing the quality and relevance of evidence medicine through the synthesis and dissemination of comparative clinical effectiveness research findings”.

Say what??

Since insurers must pay the fee with respect to insured plans, the following discussion will center on obligations of self-funded plan sponsors. For calendar year plans, the first payment is due July 31, 2013. Employers sponsoring self-insured plans need to be aware of these issues now since 2012 plan data will be necessary to calculate the fee owing in 2013.

The regulations describe how the new fee is calculated and paid by sponsors of self-insured plans for plan years ending on or after Oct 1, 2012 and before Oct 1, 2019, when the fee is scheduled to expire. The fee is based on the number of lives covered by the plan, which means the sponsor pays on the basis of participants (including COBRA recipients), as well as covered spouses, dependents and other beneficiaries.

Since the fee affects all plans with plan years ending on and after Oct 1, 2012, it is required for most plans this year, including all calendar year plans. For plan years ending before Oct 1, 2013 (for most plans, the current plan year), the fee is $1 times the average number of lives covered by the plan.

For plan years ending on and after Oct 13, 2013, the fee is $2 per average number of lives, and for years ending after Oct 13, 2014, the fee will increase based on the projected per capita amount of national health expenditures. Fees are due no later than July 31 of the year following the last day of the plan year. For calendar year plans, that means the first fee is due July 31, 2013.

For more detailed information, please review the full alert on Fisher & Phillips LLP website.