#health insurance providers
Affordable Care Act Provision 9010 —- Health Insurance Providers Fee
Section 9010 of the Patient Protection and Affordable Care Act (ACA) imposes a fee on each covered entity engaged in the business of providing health insurance for United States health risks. The first filings are due from covered entities by April 15, 2014 and the first fees are due September 30, 2014.
Change of Mailing Address
Internal Revenue Service
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Mail Stop 4916 IPF
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A covered entity is generally any entity with net premiums written for health insurance for United States health risks during the fee year that is (1) a health insurance issuer within the meaning of section 9832(b)(2); (2) a health maintenance organization within the meaning of section 9832(b)(3); (3) an insurance company that is subject to tax under subchapter L, Part I or II, or that would be subject to tax under subchapter L, Part I or II, but for the entity being exempt from tax under section 501(a); (4) an insurer that provides health insurance under Medicare Advantage, Medicare Part D, or Medicaid; or (5) a non-fully insured multiple employer welfare arrangement (MEWA).
The term covered entity generally does not include
- A self-insured employer
- A governmental entity
- Certain nonprofit corporations
- Certain voluntary employees’ beneficiary associations (VEBAs)
United States Health Risk
A United States health risk is the health risk of any individual who is (1) a United States citizen, (2) a resident of the United States (within the meaning of section 7701(b)(1)(A)), or (3) located in the United States, with respect to the period such individual is so located.
For more information on how the special rule for expatriate health plans for the 2014 and 2015 fee years under the Expatriate Health Coverage Clarification Act of 2014 applies to the health insurance provider fee under ACA § 9010, please see the Notice 2015-29 .
Health insurance generally has the same meaning as the term “health insurance coverage” in section 9832(b)(1)(A), defined to mean benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a covered entity. The term health insurance includes limited scope (also called stand-alone) dental and vision benefits under section 9832(c)(2)(A) and retiree-only health insurance.
Each covered entity, including each controlled group that is treated as a single covered entity, must report its net premiums written for health insurance of United States health risks during the previous year to the IRS by April 15 th of the year in which the fee is due (the fee year) on Form 8963 (pdf. 64.65KB) “Report of Health Insurance Provider Information” in accordance with the instructions (pdf, 150.38KB) for the form.
Covered entities are encouraged to submit Form 8963 via e-file. E-file reduces the risk of transcription errors and reduces the report processing time. In addition, electronic filers receive immediate acknowledgement of receipt and are able to track submission status online.
Controlled groups must select a designated entity, which is responsible for filing the Form 8963 on behalf of the controlled group members and maintaining documentation of the members’ consents to the selection of the designated entity. If a controlled group does not select a designated entity, the IRS will select the designated entity (members are deemed to have consented to the IRS’s selection).
Calculating the Fee
The annual fee for each covered entity is equal to an amount that bears the same ratio to the applicable amount as the covered entity’s net premiums written for health insurance of United States health risks during the data year taken into account bears to the aggregate net premiums written for health insurance of United States health risks of all covered entities during the data year taken into account.
Applicable amount means the aggregate fee amount each year for all covered entities under section 9010. The applicable amounts for fee years are—