Comparative Effectiveness Research Plan Fee
The Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks and benefits of medical treatments. This study is also known as comparative effectiveness research (CER). PCORI is a nonprofit, nongovernmental organization supported by a trust fund that is financed in part by fees from health plan issuers (for fully insured plans) and plan sponsors (for self-funded plans). The fees are to be collected for plan years and policy years that end after September 30, 2012, and before October 1, 2019.
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Plan/policy years ending October 1, 2012, through September 30, 2013
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Plan/policy years ending October 1, 2013 through September 30, 2014
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Plan/policy years ending October 1, 2014 through September 30, 2019
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$1 multiplied by the average number of covered lives ($1 per year)
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$2 multiplied by the average number of covered lives ($2 per year)
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$2 (adjusted for medical inflation) multiplied by the average number of covered lives ($2 adjusted per year)
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The calculation is based on the average number of lives covered by accident and illness insurance during the year. Fees do not apply to any insurance if substantially all of its coverage is HIPAA-excepted (such as standalone dental and vision plans), or the policy is issued specifically to cover primarily employees who are working and residing outside of the United States.
Fully Insured Customers:
We will pay the fee on behalf of our fully insured customers. It will be included as part of their premium and will be included in the total renewal amount.
ASO Customers:
For customers who have self-insured (ASO) plans, we will not pay the fee on their behalf.
Combined Funding Customers:
For customers who have a combination of funding mechanisms, we will pay the fee for the fully insured plan, but not the ASO plan.
http://www.makinghealthcarereformwork.com/healthcarereform/pdf/ANA_BCBS_CER_FEE_042712.pdf
