The IRS recently released the Patient-Centered Research Institute (PCORI) fee rate for plan years ending on or after October 1, 2020 and before October 1, 2021. For these plans, the PCORI fee is $2.66 per covered life. The IRS previously released the PCORI fee rate for plan years ending on or after October 1, 2019 and before October 1, 2020, which is $2.54 per covered life.
Which Plans are Subject to the PCORI Fee
Employers with self-insured group health plans, including level funded plans and health reimbursement arrangements (HRAs), must pay the PCORI fee.
PCORI Fee Due Date
For plan years ending in 2020, the PCORI fee is due by August 2, 2021 (the traditional July 31st deadline is extended because this July 31st falls on a Saturday).
The PCORI fee was established as part of the Affordable Care Act (ACA) to fund research to evaluate the effectiveness of medical treatments, procedures and strategies that treat, manage, diagnose or prevent illness or injury. The ACA requires certain carriers and health plan sponsors (i.e., employers) to pay the PCORI fee annually. Insurance carriers are responsible for paying PCORI fees on behalf of fully insured plans; whereas employers are responsible for paying the fee on behalf of self-insured plans.
PCORI Fee Calculations
The PCORI fee is determined by the number of covered lives under each self-insured health plan and the rate per covered life (as determined by a plan year’s end date), as summarized below:
PCORI Fee = Rate Per Covered Life x # of Covered Lives Under the Self-Insured Plan
The IRS increases the rate per covered life each year depending on the value of national healthcare expenditures. The applicable rate per covered life is determined by a plan year’s end date. This year, employers will pay the fee for plan years ending in 2020. The rate per covered life for plan years ending in 2020 are as follows:
|Plan End Dates||PCORI Fee|
|For plan years that END January 2020 through September 2020||$2.54 per covered life|
|For plan years that END October 2020 through December 2020||$2.66 per covered life|
For a further discussion on how to calculate the PCORI Fee, see our blog article.
Employer Action Items
- Employers that only sponsored fully insured plans in 2020 have no action item (insurance carriers are responsible for paying the fee for these plans).
- Employers that sponsored self-insured plans in 2020 (including level funded plans or HRAs) should calculate the PCORI fee and report and pay PCORI fees by August 2, 2021.
Disclaimer: This content is intended for informational purposes only and should not be construed as legal, medical or tax advice. It provides general information and is not intended to encompass all compliance and legal obligations that may be applicable. This information and any questions as to your specific circumstances should be reviewed with your respective legal counsel and/or tax advisor as we do not provide legal or tax advice. Please note that this information may be subject to change based on legislative changes. © 2021 Sequoia Benefits & Insurance Services, LLC. All Rights Reserved