Benefit consultants have made preliminary projections. Aon Hewitt, for example, estimates that the 2014 assessment will be in the range of $60 to $80 per healthcare plan participant, while Towers Watson & Co. puts the first-year assessment range at between $70 and $90 per plan participant.
Consultants don't expect official guidance on the amount of the fee per participant until at least this fall.
“Regulators are expected to issue a notice this fall that spells out exactly how the per-capita fee will be imposed on plan participants,” Mercer L.L.C. said in a report last week. The guidance will come from the U.S. Department of Health and Human Services which, under the healthcare reform law, was given such regulatory authority.
And there are plenty of other unknowns. For example, guidance is needed on the methodology to be used in counting the number of plan participants. Such guidance is critical, since the number of people enrolled in an employer's healthcare plan could vary considerably during a year.
“Employers need to know as soon as possible how much this is going to cost them,” Ms. Young said.
Other details are clear. For example, the fee will be assessed for every healthcare plan participant, regardless of employer size.
“There is no small-employer exemption in this part of the law,” said Amy Bergner, a Mercer partner in Washington.
In the case of fully insured plans, the fee will be paid by insurers. For self-funded plans, third-party administrators are to remit the fee on behalf of their clients. Fees are to be paid quarterly, with the first payment due Jan. 15, 2014.
Certain healthcare-related plans are exempt from the fee, including stand-alone dental, vision and flexible spending accounts, as well as Medicare Advantage and Medicare Part D prescription drug plans.
Benefit experts say the fee also will apply to retiree healthcare plans, as well as to health reimbursement arrangements. But it is unclear how the fee would be assessed when HRAs are involved.
Guidance provided by the IRS this year might serve as a model for how HRAs are treated under the transitional reinsurance program. That guidance involved another healthcare reform law provision that imposes a small fee on healthcare plans to fund research on medical outcomes.
Under those proposed rules, an employer with an HRA linked to a self-funded high-deductible healthcare plan would be liable for the fee only for participants in its healthcare plan. It would not pay a second fee for participants in the HRA.
On the other hand, the fee would be imposed on HRAs if the arrangement were linked to an insured healthcare plan. In that situation, the employer would be liable for the fee covering participants in the HRA, while the insurer would be liable for the fee on the insured plan.
Despite the big fees employers face under the reinsurance program, few even know about the program, let alone their potential costs. “It has been a big sleeper issue,” Buck Consultants' Mr. Stover said.
“This has not garnered as much attention as other provisions” in the healthcare reform law, Mercer's Ms. Bergner said.
But employer awareness is increasing as word of its effect is spreading in the benefits community amid efforts of some trade groups to publicize the provision.
The American Benefits Council, for example, held a webinar this month for its members about the program.