§4376 — Title 26 Internal Revenue Code | U.S. Code

Summary

Requires certain self-insured health plans to pay a yearly fee based on how many people they cover. For plan years ending after September 30, 2012, the fee is $2 for each average covered life (but $1 for plan years that end during fiscal year 2013). The plan sponsor must pay the fee — that means the employer, the union, or the group that runs a multi-employer or cooperative plan. An "applicable self-insured health plan" is any accident or health plan that provides any coverage not through an insurance policy and that is run by employers, employee organizations, both together, a VEBA (501(c)(9)), certain nonprofit associations (501(c)(6)), or multi-employer or rural cooperative arrangements. For plan years ending in fiscal years starting after September 30, 2014, the per-person dollar amount is increased each year by the percentage rise in projected per-capita National Health Expenditures published before that fiscal year. The fee stops applying to plan years ending after September 30, 2029.

Title 26, §4376

Internal Revenue Code — Source: USLM XML via OLRC

(a)In the case of any applicable self-insured health plan for each plan year ending after September 30, 2012, there is hereby imposed a fee equal to $2 ($1 in the case of plan years ending during fiscal year 2013) multiplied by the average number of lives covered under the plan.

(b)(1)The fee imposed by subsection (a) shall be paid by the plan sponsor.

(2)For purposes of paragraph (1) the term “plan sponsor” means—

(A)the employer in the case of a plan established or maintained by a single employer,

(B)the employee organization in the case of a plan established or maintained by an employee organization,

(C)in the case of—

(i)a plan established or maintained by 2 or more employers or jointly by 1 or more employers and 1 or more employee organizations,

(ii)a multiple employer welfare arrangement, or

(iii)a voluntary employees’ beneficiary association described in section 501(c)(9), the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan, or

(D)the cooperative or association described in subsection (c)(2)(F) in the case of a plan established or maintained by such a cooperative or association.

(c)For purposes of this section, the term “applicable self-insured health plan” means any plan for providing accident or health coverage if—

(1)any portion of such coverage is provided other than through an insurance policy, and

(2)such plan is established or maintained—

(A)by 1 or more employers for the benefit of their employees or former employees,

(B)by 1 or more employee organizations for the benefit of their members or former members,

(C)jointly by 1 or more employers and 1 or more employee organizations for the benefit of employees or former employees,

(D)by a voluntary employees’ beneficiary association described in section 501(c)(9),

(E)by any organization described in section 501(c)(6), or

(F)in the case of a plan not described in the preceding subparagraphs, by a multiple employer welfare arrangement (as defined in section 3(40) of Employee Retirement Income Security Act of 1974), a rural electric cooperative (as defined in section 3(40)(B)(iv) of such Act), or a rural telephone cooperative association (as defined in section 3(40)(B)(v) of such Act).

(d)In the case of any plan year ending in any fiscal year beginning after September 30, 2014, the dollar amount in effect under subsection (a) for such plan year shall be equal to the sum of such dollar amount for plan years ending in the previous fiscal year (determined after the application of this subsection), plus an amount equal to the product of—

(1)such dollar amount for plan years ending in the previous fiscal year, multiplied by

(2)the percentage increase in the projected per capita amount of National Health Expenditures, as most recently published by the Secretary before the beginning of the fiscal year.

(e)This section shall not apply to plan years ending after September 30, 2029.

Editorial Notes

References in Text

section 3(40) of Employee Retirement Income Security Act of 1974, referred to in subsec. (c)(2)(F), is classified to section 1002(40) of Title 29, Labor.

Amendments

2019—Subsec. (e). Pub. L. 116–94 substituted “2029” for “2019”.

§4376 Self-insured Health Plans

Summary

Title 26, §4376

Notes & Related Subsidiaries

Editorial Notes

References in Text

Amendments

Citations & Metadata