Blue Cross and Blue Shield of Illinois

 


January 25, 2013

Legislative Update: Update Regarding the PCORI Final Rule

The IRS released its final rule on the Patient-Centered Outcomes Research Institute (PCORI) Fee on Dec. 6, 2012. The final rule reflects few changes from the proposed rule. Below are highlights of the final rule:

  • The IRS did not adopt recommendations to include standards intended to prevent double counting individuals with coverage under a group health plan through two separate insurance policies (example: affiliated insurers providing separate policies for in-network and for out-of-network services). 
  • The rule includes provisions allowing the sponsor of an applicable self-insured health plan that provides coverage through both fully insured and self-funded options to participants and beneficiaries to exclude individuals covered solely by the insured option when reporting the number of covered lives that will be subject to the PCORI fee.
  • The rule clarifies that the fee does not apply to employee assistance, disease management or wellness programs as long as they do not provide significant benefits in the nature of medical care or treatment.
  • The rule makes clear that the fee is applicable to retiree coverage and to coverage provided pursuant to COBRA or similar state or federal continuation coverage requirements.
  • The final rule includes special rules to determine the number of covered lives during the first and last years the fee is in effect.
  • The final rule (consistent with the proposed rule) does not provide for third-party reporting or payment of the PCORI fee.

In accordance with the PCORI final rule, Blue Cross and Blue Shield of Illinois (BCBSIL) will not assume any reporting or fee-related responsibility for its self-funded business. We recommend groups seek the advice and counsel of qualified tax and legal professionals. For fully insured business, BCBSIL will report and remit the fee.

If you have any further questions, do not hesitate to contact your BCBSIL representative or call our ACA Fees Hotline at 888-775-6892, Monday to Friday, 8:30 a.m. to 5 p.m. CT.

 
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.