2022 PCORI Story

Created by the Affordable Care Act, the goal of PCORI is to help patients and those who care for them make better-informed decisions about healthcare choices.

img

The Affordable Care Act (ACA) created a research institute known as the Patient-Centered Outcomes Research Institute (PCORI). The goal of PCORI is to help patients and those who care for them make better-informed decisions about healthcare choices. PCORI is funded in part by fees which are charged to health plans. The following information is designed to help employers understand their upcoming payment obligations.

Fee Amount: The upcoming fee amount depends on when the plan year ended:

  • Plan years ending between January 1, 2021 and September 30, 2021 = $2.66 per covered person
  • Plan years ending between October 1, 2021 and December 31, 2021 = $2.79 per covered person

Plan Year Ending Date: This is the last day of the plan year. As an example, a plan that had a July 1, 2020, effective date would have a plan year ending date of June 30, 2021. Alternatively, a plan that had an effective date of January 1, 2021 would have a plan year ending date of December 31, 2021.

Due Date: The fees are due by July 31, 2022 for plan years which ended in 2021.

Fully Insured Health Plans: The insurance company is responsible for paying the PCORI fee, though most employers with fully insured health plans are indirectly paying these fees through slightly higher premiums.

Self-Funded Health Plans (including Level Funded Health Plans): The employer is responsible for paying the PCORI fee. The fee is determined based on the average number of covered lives in the plan year ending in 2021. An easy way to calculate the average number of covered lives is using a snapshot method. Under this method, an employer picks one day during each quarter of the plan year (e.g., Jan 1, Apr 1, Jul 1, Oct 1), adds the total number of covered lives (including spouses and dependents) for those days, and divides that number by 4.

Non-Integrated HRAs: These are Health Reimbursement Arrangements (HRAs) which are not tied to a traditional group health plan and will generally include Qualified Small Employer HRAs (QSEHRAs), Individual Coverage HRAs (ICHRAs), and certain Retiree HRAs. The PCORI fee for these types of HRAs should be calculated the same way as the self-funded health plans referenced above. However, if the non-integrated HRA only reimburses dental and/or vision expenses, no PCORI fee applies to the HRA.

Special Rules for Integrated HRAs: These are HRAs that are only available to employees who are also enrolled in a traditional group health plan. Employers that have a fully insured health plan coupled with an integrated HRA must pay the PCORI fee for the HRA, but they may treat each HRA participant as a single covered life. In other words, the fee generally does not apply to spouses or dependents covered under the HRA. Employers with a self-funded health plan and an integrated HRA may treat the coverage as a single plan assuming both plans have the same plan year.

FSAs: Flexible Spending Accounts (FSAs) are not subject to PCORI fees if they are considered an excepted benefit. To be considered an excepted benefit, employees must be offered a traditional group health plan, and if the employer contributes to the FSA, the employer may not contribute more than (the greater of) $500 or a dollar-for-dollar match of the employee’s contribution.

HSAs: Health Savings Account (HSAs) are not subject to PCORI fees.

Dental and Vision Plans: Stand-alone dental and vision plans are not subject to PCORI fees.

Making Payments: Employers should complete Form 720 to make payments. Be sure to use the form version that has a June 2022 revision date which can be located at this website.

Extension of PCORI Fees: At the end of 2019, Congress passed a spending bill which extended the payment of PCORI fees for 10 additional years. PCORI fees will continue to apply to applicable health plans through the fiscal year ending in 2019, with final payments now scheduled to be due in 2030.

Questions? Contact us at (855) 563-6993.