PCORI Fees in Health Insurance Plans to be Increased in 2018
PCORI fees, which are used to fund research on patient-centered outcomes, apply to plan and policy years ending before Oct. 1, 2019. The function gives the fee its name, the Comparative Effectiveness Research Fee (sometimes referred to as “CER fees” or “PCORI assessment”). Insurers pay this fee for a fully-insured plan with the cost being built into the premium. Self-insured plan sponsors are responsible for the payment and filing of the fee.
The amount of the fee is adjusted each year for inflation. On Oct. 6, 2017, the Internal Revenue Service issued IRS Notice 2017-61 providing that the PCORI fee will increase by 13 cents.
Fees and Form
The fee is based on the average covered lives for the applicable 12-month policy or plan year. As a reminder, if an employer’s ERISA plan year is different than their policy year, then the ERISA plan year is used for calculating the fee. CER/PCORI fees are due by July 31, 2018 for 2017 calendar plan years and for plan years ending on or after Oct. 1, 2016 and before September 30, 2017.
• For 2017 calendar plan years, employers must pay a $2.39 per average covered life fee by July 31, 2017.
• For plans ending on or after October 1, 2016 and before Sept. 30, 2017, employers must pay a $2.26 per covered life fee by July 31, 2018.
Plan fees must be paid via IRS Form 720 Quarterly Federal Excise Tax Return annually, a plan sponsor will report and pay the fee on the second quarter Form 720.
There is a special rule for the PCORI fee when coverage is provided under multiple self-insured health plans:
• Generally, separate fees apply for lives covered by each specified health insurance policy or applicable self-insured health plan.
• However, two or more applicable self-insured health plans may be combined and treated as a single applicable self-insured health plan for purposes of calculating the PCORI fee but only if the plans have:
o The same plan sponsor; and
o The same plan year.
For example, if amounts in an HRA may be used to pay deductibles and copays under a fully insured health policy, the HRA (an applicable self-insured health plan) and the policy would be subject to separate PCORI fees.
However, an HRA that may be used to pay deductibles and copays under an applicable self-insured health plan is not subject to a separate fee (and the fee will apply only to the applicable self-insured health plan) if both the HRA and the applicable self-insured health plan have the same plan sponsor and the same plan year.
The PCORI fee is not payable until July 31 of next year. However, as employers budget for the new year, the 13 cents per average covered life increase recently published by the IRS needs to be taken into consideration. JRG will publish a reminder of the fee and additional information as the July 31, 2018 due date nears.