PCORI Fee Announced for Year 3 of Program

The Internal Revenue Service (IRS) issued Notice 2014-56 announcing the PCORI fees applicable to health plans for plan and policy years ending on or after October 1, 2014 and before October 1, 2015 is $2.08. These fees are calculated using an average number of covered lives and an annually announced applicable dollar amount. The applicable dollar amount for plan and policy years ending on or after October 1, 2012 and before October 1, 2013 was $1.00. This dollar amount was increased to $2.00 for plan and policy years ending on or after October 1, 2013 and before October 1, 2014.

For policy years and plan years ending October 1, 2015, through September 30, 2019, the adjusted applicable dollar amount will be published in future guidance in the Internal Revenue Bulletin.

Plans Must Obtain Health Plan Identifier (HPID)

As part of the effort to standardize health plans’ electronic transactions, all group health plans are required to obtain a health plan identifier (HPID). The HPID is a 10-digit number assigned to health plans and will be used to identify the plan in standard transactions. Proposed regulations about the HPID were issued by HHS on April 27, 2012. Final regulations followed shortly after on September 5, 2012. Large health plans must obtain a HPID by November 5, 2014. Small health plans with less than $5 million in benefits per year have a one year extension and must obtain a HPID by November 5, 2015.

If a plan is fully insured, the insurance carrier is responsible for obtaining the HPID. If a plan is self-insured, the plan sponsor must obtain the HPID. If a plan sponsor’s health plan has both fully-insured and self-insured options, or has multiple self-insured options, the plan sponsor may obtain one HPID as the controlling health plan. Plans must apply for HPIDs at https://portal.cms.gov/wps/portal/unauthportal/home/. CMS has resources available to assist plans through the application process. For assistance in determining whether your plan is required to apply for an HPID or for assistance with the application process, please contact The McKeogh Company.   Continue reading