Eligibility
Applies to programs established under Medicare, Medicaid, CHIP, and federal programs for the Armed Forces, veterans, or Indian tribes.
Frequently Asked Questions
Who is eligible for the Governmental Health Program Fee Exemption?
Applies to programs established under Medicare, Medicaid, CHIP, and federal programs for the Armed Forces, veterans, or Indian tribes.
How does the Governmental Health Program Fee Exemption work?
Exempts specific governmental health programs from the PCORI (Patient-Centered Outcomes Research Institute) fees normally imposed on health insurance policies and self-insured plans.
What law authorizes the Governmental Health Program Fee Exemption?
The Governmental Health Program Fee Exemption is authorized under IRC §4377(b) of the Internal Revenue Code (Title 26, United States Code).
Statutory Text — IRC §4377
Source: Internal Revenue Code, Title 26, United States Code
§ 4377. Definitions and special rules(a) DefinitionsFor purposes of this subchapter—(1) Accident and health coverageThe term “accident and health coverage” means any coverage which, if provided by an insurance policy, would cause such policy to be a specified health insurance policy (as defined in section 4375(c)).
(2) Insurance policyThe term “insurance policy” means any policy or other instrument whereby a contract of insurance is issued, renewed, or extended.
(3) United StatesThe term “United States” includes any possession of the United States.
(b) Treatment of governmental entities(1) In generalFor purposes of this subchapter—(A) the term “person” includes any governmental entity, and
(B) notwithstanding any other law or rule of law, governmental entities shall not be exempt from the fees imposed by this subchapter except as provided in paragraph (2).
(2) Treatment of exempt governmental programsIn the case of an exempt governmental program, no fee shall be imposed under section 4375 or section 4376 on any covered life under such program.
(3) Exempt governmental program definedFor purposes of this subchapter, the term “exempt governmental program” means—(A) any insurance program established under title XVIII of the Social Security Act,
(B) the medical assistance program established by title XIX or XXI of the Social Security Act,
(C) any program established by Federal law for providing medical care (other than through insurance policies) to individuals (or the spouses and dependents thereof) by reason of such individuals being members of the Armed Forces of the United States or veterans, and
(D) any program established by Federal law for providing medical care (other than through insurance policies) to members of Indian tribes (as defined in section 4(d) of the Indian Health Care Improvement Act).
(c) Treatment as taxFor purposes of subtitle F, the fees imposed by this subchapter shall be treated as if they were taxes.
(d) No cover over to possessionsNotwithstanding any other provision of law, no amount collected under this subchapter shall be covered over to any possession of the United States.
(Added Pub. L. 111–148, title VI, § 6301(e)(2)(A), Mar. 23, 2010, 124 Stat. 746.)
Editorial Notes
References in TextThe Social Security Act, referred to in subsec. (b)(3)(A), (B), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.
Section 4(d) of the Indian Health Care Improvement Act, referred to in subsec. (b)(3)(D), is classified to section 1603(d) of Title 25, Indians.