Fee Obligation Comparison
| Obligation | Self-Funded Plan | Fully Insured Plan |
|---|---|---|
| PCORI fee | Employer pays directly (Form 720) | Carrier pays; included in premium |
| ACA reporting (1094-C/1095-C) | Employer responsible; may delegate to TPA | Carrier files for insured coverage; employer files for self-funded |
| Gag clause attestation | Employer responsible; may delegate to TPA | Employer responsible; may delegate to carrier |
| RxDC reporting | Employer responsible; may delegate to TPA/PBM | Carrier responsible for insured coverage |
| No Surprises Act compliance | Employer responsible; may delegate to TPA | Carrier responsible |
The Self-Funded Compliance Burden
Self-funded plans have significantly more ACA compliance obligations than fully insured plans. The employer is responsible for PCORI fees, ACA reporting, gag clause attestation, RxDC reporting, and No Surprises Act compliance — even if these tasks are delegated to a TPA. This compliance burden is one of the factors employers must consider when evaluating self-funding.
TPA Delegation
IQ Insight
Most self-funded employers delegate ACA compliance tasks to their TPA. This is appropriate — but the employer must confirm the TPA is actually performing the delegated tasks. Obtain written confirmation of completion for each delegated task. A TPA that fails to file 1095-Cs or pay the PCORI fee does not relieve the employer of the penalty.