What is the New York HCRA surcharge?
The Health Care Reform Act (HCRA) imposes a surcharge on certain medical claims to fund public health initiatives and hospitals.
Effective for services rendered from 4/1/09 through 12/31/26, the surcharge is 9.63% for payers electing to pay the amount directly to the state Public Goods Pool and an additional 28.27% for non-electing payers that pay the surcharges to healthcare providers.
How do you elect into the Public Goods Pool?
To elect into the Public Goods Pool (lowering the surcharge), payers must file monthly forms reporting patient services payments, the payer’s surcharge obligations for the month, and the payer’s total liability for covered lives. Groups are required to file the reports electronically. See more information here: https://www.health.ny.gov/regulations/hcra/questions/index.htm.
Once electing into the Public Goods Pool, a group must submit a report every month, whether or not payment is due. A group will automatically become an annual filer after one year of monthly filing if their annual pool payment liability does not exceed $25,000.
Who elects groups into the Public Goods Pool?
As a group, it is your decision whether or not to elect into the Public Goods Pool.
If you’re unsure whether your plan designer elects your group into the Public Goods Pool on your behalf, reach out to your broker.
Yuzu Health Insurance Services, the Third Party Administrator for all groups in our portal, does not elect groups into the Public Goods Pool. However, some of Yuzu’s information may be required for filing. You can find Yuzu’s general information here.