Posted Jan 11 2013
Type: Group Health Benefits
With the excitement of the new year also comes the anxiety of inevitable changes in 2013. In regards to health insurance and the Affordable Care Act (ACA), new fees will apply to health insurance issuers and self-funded plan sponsors. So how will this affect group benefits rates? UnitedHealthcare provided an informative overview back in November. Here are some of their main points about the new health reform fees:
  • Patient-centered Outcomes Research Institute (PCORI) Fee: This fee will impact both fully insured and self-funded plans. The funds paid toward this fee will be used to support research that evaluates and compares health outcomes, clinical effectiveness, risks and benefits of medical treatments and services. To put it simply, this fee will fund the research needed in order for patients and health care professionals to make better informed decisions about treatment. Effective dates: 2014-2016
  • Transitional Reinsurance Fee: This fee also impacts both fully insured and self-funded plans. It’s collected from health insurance issuers and third-party administrators on behalf of self-funded group health plans to fund the Transitional Reinsurance Program, which distributes funds to insurers in the non-grandfathered individual market that disproportionately attract those at risk for high medical costs. The purpose of this program is to spread the financial risk across all health insurers to provide financial stability. Effective dates: 2014-2016
  • Insurer Fee: The Insurer Fee will only impact fully insured plans and it will be an annual, permanent fee beginning in 2014. The purpose of the fee is to fund premium tax subsidies for individuals and families with household incomes between 100 - 400 percent of the federal poverty level who purchase health insurance through the Health Benefit Exchange. The Insurer Fee amount is determined by the market share of the health insurance provider. Effective dates: 2014- permanent
For those with fully insured plans, the funds needed to cover the fees will be collected by the insurer through premium rates. For self-funded plans, the insurer will collect the Transitional Reinsurance Fee from clients and pay the fee. As previously mentioned, the Insurer Fee does not apply to those self-funded but the Patient-centered Outcomes Research Institute research fee must be paid directly to the Internal Revenue Service.

For more information about the new health reform fees, see the full article from UnitedHealthcare and if you have questions about how the new fees will affect you or your company’s group benefits, give Prescott Pailet Benefits in Dallas a call. We are always available for any questions you may have. 2013 is sure to be a year full of changes as well as a time of preparation. 214-739-5442
Tags: unitedhealthcare; group benefits; benefits services; affordable care act; health reform fees; group benefits information