Guidance that resolves key questions about a health care reform law program is unlikely to ease self-insured employers' resentment of paying for something but receiving no direct benefit.

Final U.S. Department of Health and Human Services regulations issued earlier this month stipulate that group health care plan sponsors will have to pay $63 for every participant in their major medical plans during the first year of the three-year Transitional Reinsurance Program.

Most of the estimated $25 billion generated by the fees in the 2014-2016 program, which will be paid by health insurers offering fully-insured plans and by self-insured employers, will partially reimburse insurers that underwrite coverage in public health insurance exchanges for high-cost individuals. Some $5 billion will reimburse the government for a reform law program that subsidized claims paid by approved early retiree health plan sponsors.

Transitional Reinsurance Program costs would be hefty. For example, an employer with 100,000 participants in its health plans would have to pay the government more than $6 million in 2014.

“Writing out those checks is certain to lead to employer resentment. Large employers who will be paying millions of dollars are up in arms on why they are paying this fee,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.

“It is a large fee for which employers will receive no direct benefit,” said Amy Bergner, managing director of human resource solutions at PricewaterhouseCoopers L.L.P. in Washington.

That resentment came through in comments filed with HHS. In the preamble to the final regulations, HHS referred to a commentator expressing “concern that self-insured group health plans are excluded from receiving reinsurance payments and do not benefit proportionally or directly from their reinsurance contribution.”

While the commentator asked that self-funded employers pay less per participant, HHS responded that the law requires insurers and self-insurers to pay the entire fee.

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Given that regulatory position, the only way the fee would be reduced or eliminated for self-insured employers is through congressional action. So far, federal lawmakers haven't shown any interest in such action.

Still, HHS clarified several key issues that will aid employers in compliance. They include:

• The fee will apply to COBRA continuation coverage. Earlier, benefit lobbying groups had asked for clarification on whether COBRA beneficiaries should be counted in calculating the fee.

• The fee will apply to major medical coverage offered to pre-Medicare eligible retirees. While several groups asked for an exemption, HHS said it has “no statutory authority” to do so.

• The fee applies to Medicare-eligible employees who work after turning 65 and remain covered under their employers' plans. “For example, a working 68-year-old employee enrolled in a group health plan” who “is a beneficiary for whom Medicare is the secondary payer would be counted for purposes of reinsurance contributions,” HHS said.

• The fee is tax-deductible, HHS said, referring to Internal Revenue Service guidance on the issue.

That tax-deductibility “somewhat helps to mitigate the financial impact,” Mr. Stover said.

There are several situations, though, where the fee would not apply, HHS said.

While a self-funded employer can delegate to its third-party claims administrator the responsibility to pay the fee, the employer is liable to pay the fee if the TPA does not.

While HHS said that the 2014 fee will be $63 per participant to generate $12 billion in revenue in 2014, it hasn't announced the amount of the fee for 2015 and 2016.