ACA News & Publications

ACA Pathways: One-Year Moratorium For Health Insurance Provider Fee

April 19, 2016

Section 9010 of the Affordable Care Act (ACA) charges a fee to each covered entity engaged in the business of providing health insurance. This is known as the Health Insurance Provider Fee ("Fee"). The Consolidated Appropriations Act of 2016, passed late last year, suspended collection of this Fee for the 2016 calendar year and due in 2017 ("2017 Fee Year"). As a result, health insurance issuers are not required to pay the Fee in 2017.

The Fee is part of administrative costs for health insurance plans. Because the Fee is not being collected for the 2017 Fee Year, administrative costs for fully insured health plans in all impacted markets are expected to be adjusted appropriately to account for the moratorium. Consequently, because the Fee is typically reflected in a health plan's insurance premiums, depending upon the plan's renewal date, plan sponsors may see adjustments in either their 2016 or 2017 rates.

Under the recent legislation, the moratorium applies to the payment that would be due in the 2017 calendar year based on 2016 data. The Fee amount that would have been collected in 2017, but for the moratorium, is $13.9 billion.

The legislation is limited to one year. The moratorium has no effect on the fee amount for the 2018 fee year.

With regard to single risk pool filings in the individual and small group markets, administrative costs are one of the permissible plan-level adjustments to the index rate. The 2017 plan adjusted index rate is expected to be adjusted downward to account for the moratorium of the Fee where appropriate.

More Information

Questions and Answers have been published on the IRS' website to address the 2017 moratorium, which are available at

CMS' Center for Consumer Information and Insurance Oversight has issued frequently asked questions (FAQs) on the 2017 moratorium, which are available at

For More Information
For more information about this ACA Pathways or about any other health care reform-related provisions, please contact your Burnham Benefits consultant or Burnham Benefits at:

Burnham Benefits

This ACA Pathways is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. The information contained in this ACA Pathways includes emerging health care news from a limited perspective and does not encompass all views. The information was selected from a wide range of sources selected on the basis of their potential impact on employers and/or their employee benefit plans. For more information, please contact Burnham Benefits.

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