Wow! It is that time of year again. For those who do not know, this is a PCORI Fee reminder, and it happens every year for the sponsors of self-funded health plans. This action is a requirement under the Affordable Care Act, which was set to expire in 2019, but it has been extended for an additional 10 years. With self-funded health plans, PCORI fee payment must be submitted to the IRS by July 31 of the year following the last day of your plan year. For example, this year the payment is due August 1, 2022 since July 31 is a Sunday for the plan years ending in 2021.

The calculation of this payment is based on the average number of covered lives under the sponsored plan. Plan years ending on or after October 1, 2020 and before October 1, 2021, the fee amount per covered life is $2.66. In addition, the plan years ending on or after October 1, 2021 and before October 1, 2022, the fee amount per life is $2.79.

Of course, we know that there are some sponsors that manage multiple self-insured plans such as an HRA along with the main medical coverage, so the IRS developed special regulations in application to HRA and the PCORI payment.

  • If a sponsor does not maintain a self-insured health plan other than an HRA, they may treat each participant’s HRA as covering a single life.
  • HRA is not subject to a separate PCORI fee if the sponsor also maintains another self-insured plan providing major medical coverage, as long as the HRA and the plan (1) are established and maintained the same plan sponsor; and (2) have the same plan year.

Remember: The next PCORI fee payment is due August 1, 2022 for the self-funded health plans with their plan years ending in 2021. If you need more information on reporting and paying the fee, please follow this link to the IRS instructions along with this link for the IRS filing Form 720.

Please contact the Compliance team at Filice Insurance for further assistance regarding this payment.