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FAQ
Health Insurance Claims Assessment (HICA) Act
List of Topics
What is the Health Insurance Claims Assessment (HICA) Act?
How do I register as a Health Insurance Claims Assessment (HICA) payer?
I received a notification letter from Treasury, but do not believe I am subject to the Health Insurance Claims Assessment (HICA). What should I do?
My business activity has changed, and I am no longer subject to the Health Insurance Claims Assessment (HICA). Who do I notify?
Who do I contact if I have questions about the Health Insurance Claims Assessment (HICA)?
General Information
How do I calculate interest?
Annual Return
How will I know if Treasury has accepted my Health Insurance Claims Assessment (HICA) annual return?
If I paid Health Insurance Claim Assessment (HICA) during the return year 2012, and my business was closed in 2013, do I qualify for the Proportional Credit if it is available for the return year 2012?
How do I receive a paper copy of my Health Insurance Claims Assessment (HICA) annual return for my records?
Is there a way to save a partially completed Health Insurance Claims Assessment (HICA) annual return to come back and finish later?
Can I submit my Health Insurance Claims Assessment (HICA) annual return now, but make my payment at a later date?
If I make a mistake on my Health Insurance Claims Assessment (HICA) annual return, can I correct it?
How do I file the Health Insurance Claims Assessment (HICA) annual return?
Can I send in a paper Health Insurance Claims Assessment (HICA) annual return?
How do I log in to gain access to e-file the Health Insurance Claims Assessment (HICA) annual return?
How do I file the Health Insurance Claims Assessment (HICA) annual return if my business is located outside of the United States?
If I discontinue my business during the year, when do I need to file the Health Insurance Claims Assessment (HICA) annual return?
When will the Health Insurance Claims Assessment (HICA) annual return e-file system be available?
How do I register as a Health Insurance Claims Assessment (HICA) payer?
How do I determine the amount of my quarterly Health Insurance Claims Assessment (HICA) payment?
How do I calculate penalty?
How do I calculate interest?
How do I register to make Health Insurance Claims Assessment (HICA) payments by Electronic Funds Transfer (EFT)?
Can I mail my Health Insurance Claims Assessment (HICA) payment?
Is there a fee to submit Health Insurance Claims Assessment (HICA) payments using Electronic Funds Transfer (EFT)?
What is the format for submitting the Health Insurance Claims Assessment (HICA) quarterly payments?
What is an ACH Transaction?
What is the difference between an ACH Debit payment and an ACH Credit payment?
Do I need to notify my financial institution when making an ACH Debit payment?
What is an International ACH Transaction (IAT)?
What should I do if my Health Insurance Claims Assessment (HICA) quarterly payment is due on a weekend, legal banking holiday or a holiday recognized by Michigan?
How will I know if Treasury has accepted my Health Insurance Claims Assessment (HICA) payment?
Is there a way to review my Health Insurance Claims Assessment (HICA) payment history?
I believe I have overpaid on my quarterly Health Insurance Claims Assessment (HICA) payment, what should I do?
Can I submit a quarterly Health Insurance Claims Assessment (HICA) payment after the due date?
Can I make more than one Health Insurance Claims Assessment (HICA) payment per quarter?
Payment Information
How do I register to make Health Insurance Claims Assessment (HICA) payments by Electronic Funds Transfer (EFT)?
Can I mail my Health Insurance Claims Assessment (HICA) payment?
Is there a fee to submit Health Insurance Claims Assessment (HICA) payments using Electronic Funds Transfer (EFT)?
What is the format for submitting the Health Insurance Claims Assessment (HICA) quarterly payments?
What is an ACH Transaction?
What is the difference between an ACH Debit payment and an ACH Credit payment?
Do I need to notify my financial institution when making an ACH Debit payment?
What is an International ACH Transaction (IAT)?
Electronic Funds Transfer
Technical Information
Is there a difference between the Health Insurance Claims Assessment (HICA) and "Intent to Assess" and "Final Assessment" letters?
Does the Health Insurance Claims Assessment (HICA) Act apply to non-taxable entities such as school districts and municipalities?
"Paid claims" is defined as actual payments, net of recoveries. Does "recoveries" encompass only amounts recouped from the provider, or does it include other amounts received by the payer, such as rebates or payments from third parties?
We are a licensed third party administrator in Michigan. We do not service any self-funded employers located in Michigan, but we do service employers in other states who have employees living in Michigan. 
The only service provided by a licensed Third Party Administrator (TPA) in Michigan is health care and dependent care flex benefit administration for a client.
Are vision-related services subject to the Health Insurance Claims Assessment (HICA)?
Is "durable medical equipment" subject to the Health Insurance Claims Assessment (HICA)?
Are claims for prescription drugs, purchased through a mail-order pharmacy and delivered to a Michigan resident, subject to the Health Insurance Claims Assessment (HICA)?
Are dental services subject to the Health Insurance Claims Assessment (HICA)?
My company is self-insured, but we do use a Third-Party Administrator (TPA) for claims-related services. Can we pay the Health Insurance Claims Assessment (HICA) on our "paid claims" ourselves, or should the HICA be paid by our TPA?
Are carriers of Medicare supplemental insurance subject to the assessment under the Health Insurance Claims Assessment (HICA) Act? Should claims paid under Medicare supplemental coverage be included when determining the amount of the assessment that must
Who is a Michigan resident for purposes of the Health Insurance Claims Assessment (HICA) Act?
It appears that a group health plan sponsor will have to pay their assessment to the third party administrator and then the third party administrator will remit the assessment to Treasury. 
Our company, located in Michigan, is a self-insured entity for worker's compensation only. Does the Health Insurance Claims Assessment (HICA) Act apply to payments made on worker's compensation claims?
The Health Insurance Claims Assessment (HICA) Act refers to "ambulatory services" as one type of health and medical service that is subject to the assessment. What are "ambulatory services"?
We are a third party administrator. Our clients have zero balance checking accounts and fund only claims to be paid, into their own individual bank accounts.
We are a third party administrator. We do not actually "pay" claims for our clients, we only process those claims. The funds to pay the claims come directly from our clients' bank accounts.
Does the Health Insurance Claims Assessment (HICA) Act apply to an indemnity only insurance product? For example, the insured suffers a broken arm and the carrier pays $500 directly to the insured, regardless of treatment expense? 
On the annual return for the Health Insurance Claims Assessment (HICA) Act assessment, will we be expected to show gross paid claims and then each type of exclusion as a separate line item?
Are payments made pursuant to a health reimbursement account excluded from the Health Insurance Claims Assessment (HICA) Act? 
Who must pay the Health Insurance Claims Assessment (HICA)? 
What health-related services are subject to the Health Insurance Claims Assessment (HICA)?
Are there health-related claims that the Health Insurance Claims Assessment (HICA) does not apply to?
For services provided by a pharmacist, does the Health Insurance Claims Assessment (HICA) apply to the price of the pharmaceutical products or drugs?
Does the Health Insurance Claims Assessment (HICA) apply to employers that self-insure for health care?
If stop loss or excess insurance is purchased by a health plan sponsor, who is responsible for paying the Health Insurance Claims Assessment (HICA) on an excess claim? Is it the third party administrator, or the stop loss carrier?
We are a third party administrator that is subject to the Health Insurance Claims Assessment (HICA) Act. Doctors and other providers often use billing services
The Health Insurance Claims Assessment (HICA) Act provides for credits to be issued to payers when the assessment brings in more than $400 million in a year.
The Health Insurance Claims Assessment (HICA) Act provides for a cap on the assessment of $10,000 "per insured individual or covered life annually." 
Other taxes administered by Treasury typically have a filing threshold, below which the tax does not have to be paid. Is this true of the Health Insurance Claims Assessment (HICA) Act?
Most employees participate to some extent in the cost of their employer-sponsored health insurance. In anticipation of the new Health Insurance Claims Assessment (HICA) being added on to our monthly health insurance billing statements by our carrier
An employer pays a third party administrator to administer its wellness program, which includes a screening, a risk assessment, and an annual physical. Are such wellness expenses covered by the Health Insurance Claims Assessment (HICA)?
If a payment from a health reimbursement account is made directly to a provider, would that payment be subject to the Health Insurance Claims Assessment (HICA)? The wording of the statute only specifically excludes payments made to individuals.
How should "domestic claims" between hospitals and their employees be treated for purposes of the Health Insurance Claims Assessment (HICA) Act? Typically, when a hospital employee has treatment at the employer hospital, a claim is
I received a notification letter from Treasury, but do not believe I am subject to the Health Insurance Claims Assessment (HICA). What should I do?
My business activity has changed, and I am no longer subject to the Health Insurance Claims Assessment (HICA). Who do I notify?
Does the Health Insurance Claims Assessment (HICA) Act apply to non-taxable entities such as school districts and municipalities?
We are a third party administrator. Our clients have zero balance checking accounts and fund only claims to be paid, into their own individual bank accounts.
We are a third party administrator. We do not actually "pay" claims for our clients, we only process those claims. The funds to pay the claims come directly from our clients' bank accounts.
Who must pay the Health Insurance Claims Assessment (HICA)? 
Does the Health Insurance Claims Assessment (HICA) apply to employers that self-insure for health care?
Entities Subject to HICA
My company is self-insured, but we do use a Third-Party Administrator (TPA) for claims-related services. Can we pay the Health Insurance Claims Assessment (HICA) on our "paid claims" ourselves, or should the HICA be paid by our TPA?
It appears that a group health plan sponsor will have to pay their assessment to the third party administrator and then the third party administrator will remit the assessment to Treasury. 
If stop loss or excess insurance is purchased by a health plan sponsor, who is responsible for paying the Health Insurance Claims Assessment (HICA) on an excess claim? Is it the third party administrator, or the stop loss carrier?
Most employees participate to some extent in the cost of their employer-sponsored health insurance. In anticipation of the new Health Insurance Claims Assessment (HICA) being added on to our monthly health insurance billing statements by our carrier
Determining Which Entity Must Pay
"Paid claims" is defined as actual payments, net of recoveries. Does "recoveries" encompass only amounts recouped from the provider, or does it include other amounts received by the payer, such as rebates or payments from third parties?
We are a licensed third party administrator in Michigan. We do not service any self-funded employers located in Michigan, but we do service employers in other states who have employees living in Michigan. 
Are vision-related services subject to the Health Insurance Claims Assessment (HICA)?
Is "durable medical equipment" subject to the Health Insurance Claims Assessment (HICA)?
Are claims for prescription drugs, purchased through a mail-order pharmacy and delivered to a Michigan resident, subject to the Health Insurance Claims Assessment (HICA)?
Are dental services subject to the Health Insurance Claims Assessment (HICA)?
Are carriers of Medicare supplemental insurance subject to the assessment under the Health Insurance Claims Assessment (HICA) Act? Should claims paid under Medicare supplemental coverage be included when determining the amount of the assessment that must
Who is a Michigan resident for purposes of the Health Insurance Claims Assessment (HICA) Act?
The Health Insurance Claims Assessment (HICA) Act refers to "ambulatory services" as one type of health and medical service that is subject to the assessment. What are "ambulatory services"?
For services provided by a pharmacist, does the Health Insurance Claims Assessment (HICA) apply to the price of the pharmaceutical products or drugs?
We are a third party administrator that is subject to the Health Insurance Claims Assessment (HICA) Act. Doctors and other providers often use billing services
An employer pays a third party administrator to administer its wellness program, which includes a screening, a risk assessment, and an annual physical. Are such wellness expenses covered by the Health Insurance Claims Assessment (HICA)?
“Paid Claims”
The only service provided by a licensed Third Party Administrator (TPA) in Michigan is health care and dependent care flex benefit administration for a client.
Our company, located in Michigan, is a self-insured entity for worker's compensation only. Does the Health Insurance Claims Assessment (HICA) Act apply to payments made on worker's compensation claims?
Does the Health Insurance Claims Assessment (HICA) Act apply to an indemnity only insurance product? For example, the insured suffers a broken arm and the carrier pays $500 directly to the insured, regardless of treatment expense? 
Are payments made pursuant to a health reimbursement account excluded from the Health Insurance Claims Assessment (HICA) Act? 
What health-related services are subject to the Health Insurance Claims Assessment (HICA)?
Are there health-related claims that the Health Insurance Claims Assessment (HICA) does not apply to?
The Health Insurance Claims Assessment (HICA) Act provides for a cap on the assessment of $10,000 "per insured individual or covered life annually." 
If a payment from a health reimbursement account is made directly to a provider, would that payment be subject to the Health Insurance Claims Assessment (HICA)? The wording of the statute only specifically excludes payments made to individuals.
How should "domestic claims" between hospitals and their employees be treated for purposes of the Health Insurance Claims Assessment (HICA) Act? Typically, when a hospital employee has treatment at the employer hospital, a claim is
Exclusions from “Paid Claims”
Are claims for prescription drugs, purchased through a mail-order pharmacy and delivered to a Michigan resident, subject to the Health Insurance Claims Assessment (HICA)?
For services provided by a pharmacist, does the Health Insurance Claims Assessment (HICA) apply to the price of the pharmaceutical products or drugs?
Can rebates received by a Pharmacy Benefit Manager from drug companies be netted as "recoveries" against the PBMs "paid claims" for purposes of the Health Insurance Claims Assessment (HICA)?
We are a Pharmacy Benefits Manager (PBM). We process prescription drug claims for self-insured entities. We pay pharmacies for prescriptions that are filled, and then charge our employer client for that cost plus an administrative fee.
Are Pharmacy Benefits Managers responsible for paying the 1% assessment under the Health Insurance Claims Assessment Act (HICAA)?
Prescription Drugs and Pharmacy Benefit Managers
Are carriers of Medicare supplemental insurance subject to the assessment under the Health Insurance Claims Assessment (HICA) Act? Should claims paid under Medicare supplemental coverage be included when determining the amount of the assessment that must
We are a dental insurance carrier. We are wondering how to handle the Health Insurance Claims Assessment (HICA) with respect to subrogated Medicaid claims. Do we pay the assessment on subrogated claims?
Are self-determination services paid by a Prepaid Inpatient Health Plan (PIHP) at the direction of a consumer subject to the Health Insurance Claims Assessment (HICA)?
A Program for All Inclusive Care for the Elderly (PACE) hires its own staff to handle patients, paying those individuals salaries. No personnel are paid on a per-claim basis.
A Program for All Inclusive Care for the Elderly (PACE) contracts with other organizations to perform medical services, and pays those organizations a capitated payment every month.
Is a Program for All Inclusive Care for the Elderly (PACE) subject to the Health Insurance Claims Assessment (HICA)? These programs have outside providers perform medical services, and they are billed by and pay directly to these providers.
Are claims for hospice care subject to the Health Insurance Claims Assessment (HICA)?
Are claims paid with State general funds by a County Mental Health organization (CMH) for behavioral health services subject to the Health Insurance Claims Assessment (HICA)?
Are claims processed on behalf of charitable, non-profit programs, such as programs providing free medical service to the uninsured, subject to the Health Insurance Claims Assessment (HICA)? What about claims processed for jailed inmates?
Does the Health Insurance Claims Assessment (HICA) apply to MIChild and general fund claims paid to an organization?
We are a County Health Plan (CHP), a physical health organization that is paid capitation payments directly by the Michigan Department of Community Health to provide health care to beneficiaries of the Adult Benefit Waiver (ABW) program.
We are a Community Mental Health organization (CMH). CMHs receive capitated payments monthly from Medicaid for each member within our counties.
We are a Prepaid Inpatient Health Plan (PIHP). We have outside providers perform services, and we are billed by and pay directly to these providers. Are we subject to the Health Insurance Claims Assessment (HICA)?
We are a Medicaid Health Plan (MHP). We contract with other organizations to perform medical services, paying those organizations a capitated payment every month. The payment is for all eligible beneficiaries, and is not on a per-claim basis.
As a nonprofit dental care corporation, we contract to administer dental services to Medicaid beneficiaries through outside providers, and we are billed by and pay directly to these providers.
Are SCHIP funds exempt from the Health Insurance Claims Assessment (HICA), like some other sources of federal funding?
We are a Medicaid Health Plan (MHP). We contract with outside providers to perform medical services, and we are billed by and pay directly to these providers. Are we liable for the Health Insurance Claims Assessment (HICA)?
Prepaid Inpatient Health Plans (PIHPs) contract with County Mental Health (CMH) agencies to perform services, paying the organization a capitated payment every month.
We are a Prepaid Inpatient Health Plan (PIHP). We hire our own staff to handle all of our patients, and those individuals are paid salaries. We do not pay anyone on a per-claim basis.
We are a County Health Department. We provide medical services both through our own in-house staff and through outside providers.
We are a health plan that has been contracted by the Michigan Department of Community Health to provide medical services to beneficiaries under the MIChild program.
The Health Insurance Claims Assessment (HICA) Act provides in Section 2(b)(ii) that "payments that are made to or by an organized group of health and medical service providers in accordance with managed risk arrangements or network access agreements
Medicaid-Related Services