health care



PCORI Fees, imposed by the Affordable Care Act to employers who provide health insurance to their employees, are due Tuesday to the IRS. The fee is the amount of money paid by employers who provide health insurance to their employees and imposed by the ACA to fund the Patient-Centered Outcomes Research Institute (PCORI).

The fee is required to be reported only once a year on the second quarter Form 720 and is based on the average number of lives covered under the policy or plan.

For most 2017 plans, the PCORI fee is set at $2.26 per covered life per year. The PCORI fee will be indexed yearly to national health expenditures until it ends in 2019.

For plan years ending from October 1, 2017 through December 31, 2017, the PCORI fee is $2.39 per covered life, with the fee due on July 31, 2018.

For plan years ending from January 1, 2018 through September 30, 2018, the PCORI fee is $2.39 per life, with the fee due on July 31, 2019.

Please refer to the following chart for the filing due date and applicable rate depending upon the month a specified health insurance policy or an applicable self-insured health plan ends.

Contact us

Have questions regarding the PCORI fee for 2018? Contact a Plexus client service team representative in Deer Park, Ill. (847-307-6100), Chicago (312-606-4800), Dallas (972-770-5010) or Oklahoma City (405-840-3033).

We’re here to help – and we’re happy to help.

A primer on minimum essential coverage

Under the Affordable Care Act (ACA), employers with at least 50 full-time employees or equivalents must offer those workers, as well as their dependents, an opportunity to enroll in minimum essential coverage under an employer-sponsored plan. Without qualifying health care coverage, employees must qualify for an exemption or make an individual shared responsibility payment when filing their tax returns.

An affordability test — a comparison of proposed insurance costs for an employee against the employee’s wages — is helpful in determining the proper level of coverage. An employee’s share of the premium cannot exceed 9.56 percent of household income; if the cost exceeds this threshold, fault will lie with the employer for not providing a minimum essential affordable coverage plan.

According to the U.S. Department of Health and Human Services (HHS), employers may use one of three methods to determine if their health plan meets minimum value requirements. The first is HHS’s minimum value calculator, which lets employers enter benefit information and cost-sharing requirements to assess compliance. The second is to use safe harbor checklists, which compare the employee’s insurance cost against a number of federally determined standard, including an employee’s W-2 wages. Finally, firms can hire an actuary, who can provide certification if minimal value was accomplished.

To learn more about the ramifications of minimum essential coverage, or how to obtain cost-effective insurance solutions, contact a Plexus professional at 847.307.6100.

Effects of private exchange plans on employers

With firms of more than 50 employees required to offer workers health insurance, there are a growing number of companies turning to private exchanges for a potentially wider range of health care choices. banner-img-7An estimated three million people received employer health benefits through a private exchange, according to a 2014 report by consulting firm Accenture. This trend is expected to continue.

Those who favor the private marketplace believe these plans give employees a better selection of choices that meet their needs both personally and financially. And these plans are much easier to review and respond to with the advent of today’s technology.

Also, respected benefit management companies offer a wide range of plans designed to meet everyone’s budget. These include lower premium plans with high deductibles, as well as comprehensive plans that carry high premiums.

With mandatory employee plans comes mandatory reporting, with employers required to keep track of their employees’ benefit plans on a monthly basis. Heavy fines and other penalties can occur if these reporting functions don’t work properly. It is a time- and labor-intensive function that many employers don’t take into consideration when reviewing corporate benefit management commitments.

If you would like more information on private exchange plans, or would like to know about other strategic insurance solutions, call at 847.307.6100 and speak to a professional at The Plexus Groupe, or visit us on the web at