2016 PCORI Fee Reminder

PCORI Fee Overview and Guidance

The Affordable Care Act imposes fees on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute. The fees, required to be reported annually on the 2nd quarter Form 720 and paid by its due date, July 31st, are based on the average number of lives covered under the policy or plan. The fees apply to policy or plan years ending on or after October 1, 2012, and before October 1, 2019. HRCTS will make available an Average Covered Lives Report to all clients that are responsible to file and pay the PCORI fee each year. You can request this report by contacting your Account Management Team.

The IRS recently released the revised Form 720 that insurers and sponsors of self-insured plans will use to pay the Patient-Centered Outcomes Research Institute (PCORI) fee. The fee is due by July 31 of the year following the calendar year in which the plan/policy year ended. Sponsors of any plans that ended in 2015 must pay the 2015 fee by July 31,2016.  Plan sponsors can now complete their planning for payment of this fee. The IRS has also confirmed health insurers and self-insured health plan sponsors can deduct PCORI fees as ordinary and necessary business expenses. The fee is based on the number of covered lives including employees, retirees and COBRA participants along with their covered dependent spouses and children are all counted. However, only the employee, retiree or COBRA participant needs to be counted for an HRA or a health flexible spending account (health FSA) -- dependents covered by these accounts can be excluded.

The types of plans that must pay the PCORI Fees by July 31, 2016 include:

  • Health/accident plans
  • Health Reimbursement Arranagement (HRA) plans that are not an excepted benefit (Employer contribution is greater than $500)
  • Health Flexible Spending Account (FSA) plans that are not an excepted benefit (Plan has employer contributions with the maximum reimbursement greater than two times an employee’s salary reduction election or employer contribution is greater than $500)
  • Retiree plans

Calculating the Fee:

The amount of the PCORI fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year.

  • For plan years that end on or after October 1, 2014, and before October 1, 2015, the fee is $2.08.
  • For plan years that end on or after October 1, 2015, and before October 1, 2016, the fee is $2.17.

For policy and plan years beginning on or after Oct. 1, 2016, and before Oct. 1, 2019, the applicable dollar amount is further adjusted to reflect inflation in National Health Expenditures, as determined by the Secretary of Health and Human Services.

IRS Form 720 and Instructions:

IRS Form 720 can be accessed at http://www.irs.gov/pub/irs-pdf/f720.pdf which is an interactive document so that can be completed on line.

 

The PCORI fees are entered on line 133 for the appropriate plans. See pages 8 and 9 of the IRS Instructions for completing these fields. Instructions can be found at http://www.irs.gov/pub/irs-pdf/i720.pdf.

 

 

Complete the fields on page 7 and make your check or money order payable to “United States Treasury”.

Additional information on the PCORI fees can be found here:
Patient-Centered Outcomes Research Trust Fund Fee (IRC 4375, 4376 and 4377): Questions and Answers

• An IRS chart that shows which types of benefits the fee applies to:  Application of the Patient-Centered Outcomes Research Trust Fund Fee to Common Types of Health Coverage or Arrangements

IRS Form 720 Overview

IRS Form 720 instructions (see pages 8 to 9)

Please Note:
This information is provided for educational purposes only. It reflects the understanding of HRC Total Solutions and our partners using the available guidance as of the date shown and is subject to change. It is not intended to provide legal advice.  You should not act on this information without consulting legal counsel or tax advisors.  (Updated June 16, 2016)


2015 PCORI Fee Reminder

PCORI Fee Overview and Guidance

The Affordable Care Act imposes fees on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute. The fees, required to be reported annually on the 2nd quarter Form 720 and paid by its due date, July 31st, are based on the average number of lives covered under the policy or plan. The fees apply to policy or plan years ending on or after October 1, 2012, and before October 1, 2019. HRCTS will make available an Average Covered Lives Report to all clients that are responsible to file and pay the PCORI fee each year. You can request this report by contacting your Account Management Team.

The IRS recently released the revised Form 720 that insurers and sponsors of self-insured plans will use to pay the Patient-Centered Outcomes Research Institute (PCORI) fee. The fee is due by July 31 of the year following the calendar year in which the plan/policy year ended. Sponsors of any plans that ended in 2014 must pay the 2014 fee by July 31,2015.  Plan sponsors can now complete their planning for payment of this fee. The IRS has also confirmed health insurers and self-insured health plan sponsors can deduct PCORI fees as ordinary and necessary business expenses. The fee is based on the number of covered lives including employees, retirees and COBRA participants along with their covered dependent spouses and children are all counted. However, only the employee, retiree or COBRA participant needs to be counted for an HRA or a health flexible spending account (health FSA) -- dependents covered by these accounts can be excluded.

The types of plans that must pay the PCORI Fees by July 31, 2015 include:

  • Health/accident plans
  • Health Reimbursement Arranagement (HRA) plans that are not an excepted benefit (Employer contribution is greater than $500)
  • Health Flexible Spending Account (FSA) plans that are not an excepted benefit (Plan has employer contributions with the maximum reimbursement greater than two times an employee’s salary reduction election or employer contribution is greater than $500)
  • Retiree plans

Calculating the Fee:

The amount of the PCORI fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year.

  • For plan years that end between January 2, 2014, and before October 1, 2014 the fee will be $2.
  • For plan years that end on or after October 1, 2014, and before October 1, 2015, the fee is $2.08.
  • For plan years that end on or after October 1, 2015, and before October 1, 2016, the fee is $2.17.

For policy and plan years beginning on or after Oct. 1, 2015, and before Oct. 1, 2019, the applicable dollar amount is further adjusted to reflect inflation in National Health Expenditures, as determined by the Secretary of Health and Human Services.

IRS Form 720 and Instructions:

IRS Form 720 can be accessed at http://www.irs.gov/pub/irs-pdf/f720.pdf which is an interactive document so that can be completed on line.

 

The PCORI fees are entered on line 133 for the appropriate plans. See pages 8 and 9 of the IRS Instructions for completing these fields. Instructions can be found at http://www.irs.gov/pub/irs-pdf/i720.pdf.

 

 

Complete the fields on page 7 and make your check or money order payable to “United States Treasury”.

Additional information on the PCORI fees can be found here:
Patient-Centered Outcomes Research Trust Fund Fee (IRC 4375, 4376 and 4377): Questions and Answers

• An IRS chart that shows which types of benefits the fee applies to:  Application of the Patient-Centered Outcomes Research Trust Fund Fee to Common Types of Health Coverage or Arrangements

IRS Form 720 Overview

IRS Form 720 instructions (see pages 8 to 9)

Please Note:
This information is provided for educational purposes only. It reflects the understanding of HRC Total Solutions and our partners using the available guidance as of the date shown and is subject to change. It is not intended to provide legal advice.  You should not act on this information without consulting legal counsel or tax advisors.  (June 4, 2015)


Health Safety Net Surcharge Providers Updated

The list below is to assist Health Safety Net (HSN) surcharge payers in identifying surchargeable payments made to Massachusetts acute hospitals and ambulatory surgical centers (ASCs) for the purchase of heath care services.  The Health Safety Net annually requests that providers identify and update FEINs for all Massachusetts acute hospitals, ASCs, and certain provider organizations that receive direct and indirect payments subject to the HSN surcharge.  The list below reflects the current list of providers reported to the Health Safety Net as of July 12, 2012 and then updated for October 2014.

According to HSN regulation 101 CMR 614.00, payments that are made directly to an acute hospital or ASC for the purchase of health care services are considered direct payments and are subject to the HSN surcharge in whole.  Payments that are made to an affiliated provider or group of providers for the purchase of health care services of which a portion is then forwarded to an acute hospital or ASC are considered indirect payments.  For indirect payments, the HSN surcharge applies only to the portion forwarded to the acute hospital or ASC.

Massachusetts Acute Hospitals
Anna Jaques Hospital
Athol  Memorial Hospital
Baystate Franklin Medical Center
Baystate Mary Lane Hospital
Baystate Medical Center
Baystate Wing Hospital (formerly Wing Hospital)
Berkshire Medical Center
Beth Israel Deaconess Hospital-Plymouth (formerly Jordan Hospital)
Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center-Needham Campus
Beth Israel Deaconess-Milton (formerly Milton Hospital)
Boston Medical Center
Boston Medical Center/ Codman Square Health Center
Boston Medical Center/ Dorchester House
Boston Medical Center/ East Boston NHC
Boston Medical Center/ South Boston CHC
Brigham and Women's Hospital
Cambridge Health Alliance - Cambridge Campus
Cambridge Health Alliance/ Cambridge Health Alliance Physician Org
Cape Cod Hospital
Children's Hospital
Clinton Hospital
Cooley Dickinson Hospital
Dana Farber Cancer Institute
Emerson Hospital
Fairview Hospital
Falmouth Hospital
Faulkner Hospital
Hallmark Health Systems
Harrington Memorial Hospital
Health Alliance Hospitals, Inc
Heywood Hospital
Holy Family Hospital at Merrimack Valley
Holyoke Medical Center, Inc.
Kindred Hospital Boston
Kindred Hospital North Shore
Lahey Clinic Hospital
Lahey Clinic Hospital /Lahey Clinic Foundation, Inc.
Lahey Clinic Hospital MRI Services, LLC
Lawrence General Hospital
Lowell General Hospital
Lowell General Hospital-Saints Campus (formerly Saints Medical Center)
Marlborough Hospital
Martha's Vineyard Hospital
Mass General Hospital
Mass. Eye & Ear Infirmary
Mercy Medical Center (includes Providence Hospital)
Metro West Medical Center
Milford Regional Medical Center, Inc
Morton Hospital and Medical Center
Mount Auburn Hospital
Nantucket Cottage Hospital
Nashoba Valley Medical Center, A Steward Family Hospital, Inc.
New England Baptist Hospital
Newton-Wellesley Hospital
Noble Hospital
North Shore Medical Center (includes Salem & Union Hospital)
Northeast Hospital
Quincy Medical Center
Saint Vincent Hospital
Shriners Hospital-Boston
Shriners Hospital- Springfield
Signature Healthcare Brockton Hospital (listed previously as Brockton Hospital)
South Shore Hospital
Southcoast Hospitals Group, Inc. (listed previously as Southcoast Health Systems)
Steward  Norwood Hospital
Steward Carney Hospital Inc.
Steward Good Samaritan Medical Center
Steward Holy Family
Steward Saint Anne's Hospital
Steward St. Elizabeth's Medical Center
Sturdy Memorial Hospital
Tufts Medical Center (listed previously as Tufts New England Medical Center)
UMass. Memorial Medical Center
Winchester Hospital

Massachusetts Ambulatory Surgical Centers
Advanced Eye Surgery Center, LLC
ARC Worcester Center, LP d/b/a Worcester Surgical Center
Berkshire Cosmetic and Reconstructive Surgery Center
Berkshire Endoscopy Center LLC
Boston Center for Ambulatory Surgery, Inc.
Boston Endoscopy Center
Boston Eye Surgery and Laser Center, Inc.
Boston Laser Group
Boston Outpatient Surgical Suites, LLC
Boston Surgery Center, LLC (new effective 9/29/09)
Boston University Eye Associates Surgery and Laser Center formerly University Eye Associate)
Candescent Eye Health Surgi Center (d/b/a Greater New Bedford Surgicenter)
Cape and Islands Endoscopy Center, LLC
Cape Cod ASC, LLC
Cape Cod Eye Surgery and Laser Center
Cape Cod Surgery Center, Inc.
Cataract & Laser Center West, LLC.
Cataract & Laser Center, Inc.
Cataract and Laser Center  of the North Shore, LLC
Cataract and Laser Center Assoc. (Adams)
Cataract and Laser Center Central, L.L.C.
Central Massachusetts Ambulatory Endoscopy Center, LLC
Charles River Endoscopy, LLC (new effective 9/29/09)
Commonwealth Endoscopy Center, Inc.(new FEIN only effective 2/1/09)
DHA Endoscopy, LLC
East Bay Surgery Center, LLC
East Pond Enterprises Inc.
Eastern Massachusetts Surgery Center  (new effective 9/29/09)
Four Women's Health Services
Good Samaritan North Easton Surgery Center(formerly Orthopedic Care Surgi Ctr)
Greater Springfield Surgery Center, LLC
Hyannis Ear, Nose & Throat Assoc.
Hyde Park Pain Management, LLC
MD Sine, LLC dba Spine Institute of New England
Merrimack Valley Endoscopy Center, LLC
Middlesex  Endoscopy Center, LLC
New England Ambulatory Surgicenter, LLC
New England Eye Surgical Center Inc.
New England Pain Association P.C.
New England Pain Care
New England Surgery Center
New England Surgical Center for Outpatient Endoscopy, LLC
North Shore Cataract and Laser Center
Northeast Ambulatory Center, Inc
Northeast Endoscopy Center,  LLC
Orthopedic Surgical Center of North Shore, LLC
Peabody Surgery Center LLC
Pioneer Valley Surgicenter
Plymouth Laser and Surgical Center
Same Day Surgiclinic
South Shore Endoscopy Ctr, Inc.
St. Anne's Hospital Ambulatory Care Center-Hawthorne(formerly Hawthorn Endoscopy)
Surgical Eye Experts of New England
The  Surgery Center of Waltham (formerly listed as Boston IVF, Inc)
The Cataract Surgery Center of Milford, Inc. (new effective 10/05/09)
The Endoscopy Center of  Southeast Massachusetts, LLC
Valley Medical Group, P.C.
West Suburban Eye Surgery Center  dba SurgiSite Boston
Weymouth Endoscopy LLC
Women's Health Services

Affiliated Organizations
Baycare Health Partners
Baystate Medical Practices
Health Alliance with Physicians
Partners Community HealthCare Inc. (PCHI)

 


ACA Changes to HRA plans: HRA Opt-Out Option Plan Amendment

Attached please find the HRA Opt-Out Option Amendment and SMM (summary of material modifications) for your HRA plan documents. This amendment is for your company’s document and the SMM is for the summary plan description for your employees. These are not documents that we need to have returned to us at HRCTS but only for your records.

The purpose of this Amendment is to adopt the opt-out option under a Health Reimbursement Arrangement (HRA) Plan allowing employees and former employees the opportunity to permanently opt out of and waive future reimbursements from the HRA at least annually. Upon termination of employment, the HRA must either be forfeited, or it must allow the employee to permanently opt out of and waive future reimbursements.

HRCTS will include this in any HRA document that we prepare for you in the future.  If you would like more information on the HRA Opt-Out Amendment please review the following IRS publication here and contact our sales team.
 


New Proposed Regulations for HRA Plans

New Proposed Regulations for HRA Plans

Recently the United States Departments of Labor, Health and Human Services and the Treasury announced important regulatory FAQs about the implementation of various provisions of the Patient Protection and Affordable Care Act (PPACA), including clarification regarding the use of HRAs to purchase coverage on the individual market. The most important of these FAQs states that federal regulations will be issued that prohibit use of so-called standalone HRAs for the purpose of funding payment of premiums for individual insurance policies.
In response to this guidance HR Concepts is in the process of implementing the plans and technology to support both HRA-based and Cafeteria Plan-based Defined Contribution models. HR Concepts is working diligently to offer a compliant defined contribution solution for our clients and participants.  We will provide additional updates in the coming months as it relates to these new plan offerings.


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