Confusion regarding ACA fees

Lost among the hue and cry about the Affordable Care Act (ACA) is the burden of responsibility placed on employers regarding health care coverage, costs and reporting requirements.

Many employers in both the nonprofit and for-profit sectors are still trying to get the details right, including their financial obligations.

Speaking during the American Institute of CPAs (AICPA) Not-for-Profit-Industry Conference, Eddie Adkins of Grant Thornton said that many employers are still confused about fees associated with the Patient-Centered Outcomes Research Institute (PCORI), which was established by the ACA. This confusion is increased when employers have such things as flexible spending accounts (FSAs).

The following programs are not subject to the PCORI fee:

  • Employee assistance programs, disease management programs and wellness programs, unless the programs provide significant benefits in the nature of medical care or treatment.
  • Plans designed to cover primarily employees outside the United States.
  • Dental and vision, long-term care, nursing home care, home health care and community-based care plans that are offered on a standalone basis.
  • Coverage for only a specified disease or illness, hospital indemnity and fixed indemnity insurance, if offered as independent benefits that are not coordinated with any other plans that are maintained by the employer.