The IRS recently released Notice 2022-4, which outlines the Patient-Centered Research Institute (PCORI) fee rate for plan years ending on or after October 1, 2021 and before October 1, 2022. For these plans, the PCORI fee rate is $2.79 per covered life. The IRS previously released the PCORI fee rate for plan years ending on or after October 1, 2020 and before October 1, 2021, which is $2.66 per covered life.

Employers who sponsored self-insured group health plans in 2021 must submit the PCORI fee by August 1, 2022.

Plans 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 2021, the PCORI fee is due by August 1, 2022 (the traditional July 31st deadline is extended because July 31, 2022 falls on a Sunday).

Background

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.

Though the PCORI Fee was previously set to expire in 2019, the fee was extended an additional 10 years through 2029.

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 all plan years ending in 2021. The rates per covered life for plan years ending in 2021 are as follows:

Plan End DatesPCORI Fee Rate
For plan years that END January 2021 through September 2021$2.66 per covered life
For plan years that END October 2021 through December 2021$2.79 per covered life

For more on the PCORI fee, see the IRS PCORI Fee Q&A.

Employer Action Items

  1. Employers that only sponsored fully insured plans in 2021 have no action item (insurance carriers are responsible for paying the fee for these plans).
  2. Employers that sponsored self-insured plans in 2021 (including level funded plans or HRAs) should calculate the PCORI fee, report the fee on IRS Form 720, and pay PCORI fees to the IRS by August 1, 2022.

Additional Resources

Emerald Law — Emerald is a Senior Compliance Consultant for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Emerald enjoys stand-up comedy, live music, and writing non-fiction.