2015 Comparative Effectiveness Research Fee (CERF)

 

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2015 Comparative Effectiveness Research Fee (CERF)The Comparative Effectiveness Research Fee (CERF), also known as the Patient-Centered Outcomes Research Institute (PCORI) Fee, is one of several fees introduced as part of the Patient Protection and Affordable Care Act (PPACA). The fees collected are used to fund research to determine the effectiveness of alternative treatments.This email is intended to provide Cigna’s self-insured clients, which includes those sponsoring and Health Reimbursement Accounts (HRAs) or Flexible Spending Accounts (FSAs), with information and resources to help prepare for the upcoming payment due by July 31, 2015, as well as how Cigna will support them throughout this process.CERF Overview

  • This fee applies to both insured and self-insured group health plans.  Cigna pays the fee for insured plans with the anticipated cost built into its insurance policy premiums.
  • Self-insured plans must calculate and pay their own fee. The regulations do not permit Cigna to pay the fee on behalf of its clients.

Please note that HRAs and FSAs are considered self-insured plans. However, there are regulations designed to avoid duplicate payment of the fee when the HRA or FSA is offered along with an insured or self-insured group health plan.

2015 CERF Payment Amounts

CERF is determined by multiplying the applicable per covered life amount by the average number of covered lives for the applicable 12-month plan year.  The average number of covered lives for self-insured plans is determined using one of three alternative counting methods:

  • Actual count method
  • Snapshot method
  • Form 5500 method

The CERF payment is paid using IRS Form 720 (the Quarterly Federal Excise Tax Return), and it is due no later than July 31 of the calendar year for the plan year that ended in thepreceding calendar year.  It’s important to remember that clients must use the ERISA plan year to calculate their fee per covered life and payment due date if their ERISA plan year and renewal date is different.

The following chart identifies the fee per covered life payable in 2015 based upon your ERISA plan year:

ERISA Plan Year Start Date   Fee Due July 31, 2015
February 1, 2013
March 1, 2013
April 1, 2013
May 1, 2013
June 1, 2013
July 1, 2013
August 1, 2013
September 1, 2013
October 1, 2013
$2 per average covered life
November 1, 2013
December 1, 2013
January 1, 2014
$2.08 per averaged covered life

Please note that self-funded clients with ERISA plan year start dates of February 1, 2014 through October 1, 2014 will make their $2.08 payment per average covered life by July 31, 2016.

Resources and Support

To best prepare and understand the steps to take by the July 31st deadline, Cigna encourages self-insured clients to review and download the following resources:

In addition, Cigna provides monthly self-service reports available by segment and by request:

  • Self-insured clients that obtain Cigna eligibility information through CignaAccess can find their reports there.
  • Self-insured clients that obtain Cigna eligibility information through the Client Resource Portal (CRP) can find their reports there.
  • If you have a Cigna Behavioral Health, Cigna Voluntary, or Cigna Global Health Benefits plan, reports are available upon request through the Cigna’s ASO PPACA Fees & Reporting Resources.

These reports support self-funded clients in determining their average covered lives and calculating their CERF payment. We will continue to provide this reporting at no cost in 2015.

If you have reviewed the above resources and still have questions about CERF, please contact Cigna’s ASO PPACA Fees & Reporting Resources. The team can provide support to clients and give answers to questions such as:

  • When is my CERF payment due?
  • When will the CERF report become available, and how can I retrieve it?
  • Where/How do I make my CERF payment?

To contact the ASO PPACA Fees & Reporting Resources team, please call 1-855-275-0555, between 8:30 a.m. – 7:30 p.m. ET Monday through Friday, or email them atASO_PPACA_Fees&Reporting@Cigna.com.

This document is for general informational purposes only. While we have attempted to provide current, accurate and clearly expressed information, this information is provided “as is” and Cigna makes no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.
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Group health insurance and health benefit plans are insured or administered by Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Group Universal Life (GUL) insurance plans are insured by CGLIC. Life (other than GUL), accident, critical illness, and disability plans are insured or administered by Life Insurance Company of North America, except in NY, where insured plans are offered by Cigna Life Insurance Company of New York. All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative.

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