Health Care Reform Notices
The Patient-Centered Outcomes Research Trust Fund fee is a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans that helps to fund the Patient-Centered Outcomes Research Institute (PCORI). PCORI helps patients, clinicians, purchasers, and policy-makers in making informed health decisions by improving the quality and relevance of evidence-based medicine.
Below is a brief overview of PCORI Fees notices.
Health Insurance Exchange Notice
The Health Insurance Exchange Notice must be provided to all benefits eligible employees within 14 days of an employees start date.
Summary of Benefits and Coverage (SBC) & Uniform Glossary
These must be provided to all group health plan participants and beneficiaries at specified times during the enrollment process and upon request.
Notice of Modification
The Notice of Modification must be provided to all group health plan participants and beneficiaries no later than 60 days prior to the effective date of a plan or coverage change that would affect the content of the SBC and that occurs other than in connection with a renewal or reissuance of coverage.
A complete & timely notice may also satisfy the requirement to provide a Summary of Material Modifications (SMM).
Disclosure of Grandfather Status
The Disclosure of Grandfather Status must be provided to all group health plan participants and beneficiaries In any plan materials for a grandfathered group health plan provided to a participant or beneficiary describing the benefits provided under the plan
Notice of Patient Protections
The Notice of Patient Protections must be provided to all group health plan participants whenever a participant in a non-grandfathered group health plan that requires or provides for the designation of a participating primary care provider is furnished an Summary Plan Description (SPD) or other similar description of benefits under the plan.
Patient- Centered Outcomes Research Institute (PCORI) Fees
These must be filed with the Internal Revenue Service (IRS). IRS Form 720 must be filed annually by plan sponsors of certain self-insured health plans, no later than July 31st of the calendar year immediately following the last day of the plan year to which a fee applies. Please click here to see the IRS FAQs on Patient-Centered Outcomes Research Trust Fund Fee (IRC 4375, 4376 and 4377).
For more information, visit this IRS page.
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