Under health care reform, Patient Protection and Affordable Care Act (PPACA), a new nonprofit corporation was established, the Patient Centered Outcomes Research Institute (PCOR). This corporation will be funded in part by PCOR/CER (Comparative Effectiveness Research) fees paid by certain health insurance issuers or plan sponsors of applicable self-insured health plans. Please note that Health Reimbursement Arrangements (HRAs) are categorized as self-insured health plans and are therefore subject to this fee unless, in rare occasions, it is determined to be an excepted benefit (i.e. for vision and dental expenses only).