IRS proposed rules modify earlier guidance by adding new requirements for employers seeking to meet the minimum-value (MV) standard for group health plans under the ACA's employer shared-responsibility (ESR) provisions. Under the proposals, which have been expected for months, group health plans won't satisfy the MV standard unless they provide substantial coverage of inpatient hospitalization and physician services as well as meet or exceed an actuarial value standard of at least 60%.
The 2015 transitional reinsurance fee form is now available for self-insured group health plan sponsors (or their third-party administrators) and health insurers to use. By Nov. 16, employers and insurers subject to the ACA fee must report annual enrollment data for their major medical plans and schedule payments, using the same account established in 2014. The 2015 fee of $44 per covered life may be paid in full by January 15, 2016, or split into two installments, with $33 per covered life due by January 15, 2016, and the rest paid by November 15, 2016.
For health plan or policy years ending on or after October 1, 2015, but before October 1, 2016, the patient-centered outcomes research (PCOR) fee has increased by 9 cents to $2.17 times the average number of covered lives under the plan or policy, according to IRS Notice 2015-60. This temporary ACA fee applies to insured and self-insured group health plans for each plan or policy year ending after September 30, 2012, and before October 1, 2019. Calendar-year arrangements will use the new $2.17 rate when calculating the PCOR fees due next July.