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Calculate the fees:

Enter annual premium and number of health plan enrollees to find out the specific fees associated with a selected health plan.

Fee Fully Insured Self-Funded
Health Insurance Industry Fee
(also known as the Health
Insurance Tax)
To determine the costs of the fee for 2014:

$ 0 annual premium
x 0.021


$ 0

Not applicable
Reinsurance Assessment Fee To determine the costs of the fee for the 2014 benefit year:

$ 63
x 0 plan participants


$ 0

$ 63
x 0 plan participants


$ 0

Patient-Centered Outcomes
Research Institute
(PCORI) Fee
To determine the costs of the fee for plan years ending on or after Oct. 1, 2012, through Sept. 30, 2013:

0 plan participants
x $1


$ 0

0 plan participants
x $1


$ 0

User Fee for Federally
Facilitated and State
Partnership Exchanges
To determine the 2014 monthly fee:2

$ 0 annual premium
x 0.035


$ 0

Not applicable
Risk Adjustment Fee To determine the costs of the fee3 for 2014:

$ 0.96
x 0 plan participants


$ 0

Not applicable
  Potential total costs for these PPACA fees for a fully insured plan:

$ 000

Potential total costs for these PPACA fees for a self-funded plan:

$ 000

Tools

To print out the calculations on this page, select “File > Print” from your browser’s menu or use “Ctrl + P” on your keyboard.

Or, download a PDF with information about PPACA fees and a worksheet that will help you estimate the potential impact of these five fees for a specific health plan.

Summary:
$ 000 (fully insured total) vs. $ 000 (self-funded total).

The cost of fees introduced by PPACA is greater for fully insured plans than for self-funded plans.

1 “Estimated Premium Impact of Annual Fees Assessed on Health Insurance Plans,” a study by Oliver Wyman dated Oct. 31, 2011
2 This calculation assumes that coverage is purchased on a federally facilitated exchange and that all fully insured product sales by the carrier are through the exchange. The 3.5% user fee does not apply to coverage offered on state-operated exchanges. However, a state-operated exchange could choose to impose its own user fee. Currently, states planning to operate their own exchange include Calif., Colo., Conn., Hawaii, Iowa, Ky., Md., Mass., Minn., Nev., N.M., N.Y., Ore., R.I., Vt. and Wash. The District of Columbia also is planning to operate its own exchange.
3 Insurance companies issuing non-grandfathered fully insured individual and small group health coverage are responsible for paying this fee. Customer rates may be impacted. For 2014, this fee is applicable in all states, except Massachusetts.


Fees for fully insured products are paid by the insurer, but client rates may be impacted.


This calculator was developed for illustrative purposes only. The final answers on this page may not represent what an actual health plan’s increase would be with fees introduced by PPACA.

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Calculate the rating:

Enter the information requested in the appropriate boxes, select a health status for the group and click on “Calculate” for the potential impact of the adjusted community rating requirements on a specific health plan.

$
   
   
   
   

*Beginning Jan. 1, 2014, health insurers will be prohibited from considering a group’s overall health status in setting rates. However, to demonstrate the impact of no longer including health status in rate calculations, we have to ask about groups’ health status today.

New adjusted community-rated premium:

$0

Tools

To print out the calculations on this page, select “File > Print” from your browser’s menu or use “Ctrl + P” on your keyboard.

Summary: $0 estimated annual group premium using current method to set rates vs. $0 estimated annual group premium with adjusted community rating

This calculator was developed for illustrative purposes only. Values on this page or a screen print of this page do not constitute a complete rate proposal and will not be honored. Statistics used to develop this calculator were derived by comparing rates of 2012 Starmark in-force groups to the estimated rates for similar products and census under expected 2014 rates. Rate impacts may vary based on factors such as prescription drug coverage, other benefit selections and number of dependents per employee.

 

PLEASE NOTE: This presentation is designed to provide a high-level overview of aspects of the Patient Protection and Affordable Care Act (PPACA), as modified by the Health Care and Education Reconciliation Act. It is not comprehensive and does not constitute legal or tax advice for healthcare reform implementation. Please consult a professional benefit adviser or legal counsel regarding how the law may impact your specific benefit plan.

For more information on PPACA, visit the Trustmark Healthcare Reform blog.

Last Updated: April 7, 2014