Healthcare Reform: PCORI Fees Appearing on Invoices in Early 2013
The federal government began assessing health plan sponsors
a Patient Centered Outcomes Research Institute fee, or PCORI fee, this fall based on federal regulations in
the Affordable Care Act. To cover this fee we will begin to include it on most fully insured group (all market
segments) and most individual account invoices in 2013.
Beginning with the earliest possible invoice in 2013,*
Medical Mutual will assess a $0.16 per member per month fee. The assessment will capture every contract holder and
dependent in the calculation. Applicable group and individual invoices will include a line item for this fee
that reflects the per-member-per-month charge. Areas of business not impacted by PCORI at this time include:
- High Risk Pool
- Medicare Supplement
- Individual Short Term
- Dental, Vision and Life
We are sending a letter to impacted 1-99 fully insured
groups and to impacted individual policy holders, as well as our 100+ and self-funded groups.
*As a courtesy to our customers, we are not assessing any
fees to our fully insured group customers or individual customers for the first three months the PCORI fee was in
place (October, November and December 2012). We will absorb this initial amount, which is about $150,000
