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Paying the PCORI Fee in 2023 (Plan Years Ending in 2022)

 

The Affordable Care Act (ACA) imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute (PCORI). The institute helps patients, clinicians, purchasers and policymakers make better-informed healthcare choices by advancing clinical effectiveness research.

The fee must be reported once a year and is due on July 31 of the year following the last day of the policy year or plan year. It is based on the average number of lives covered under the policy or plan. Issuers of self-insured medical plans (i.e., Fixed Funding Solutions), Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs), must pay this fee unless the plan is primarily for employees working/residing outside of the U.S. or is considered an excepted-benefit. If the plan is fully insured, the insurance company pays the fee on behalf of the policyholder.

  • CBIA Fixed Funding Solutions customers must file Form 720 and pay this fee directly to the IRS. A report is now available on our secure website that assists Fixed Funding Solutions customers with this filing requirement. Find the link to the report in the left-hand navigation bar, titled PCORI-Monthly Member Counts.
  • Complete the registration for online account access form if you need access to the secure employer site.
  • All Plan Sponsors (Employers) who offer an HRA integrated with a fully-insured plan must file Form 720 and pay this fee directly to the IRS. The data required for reporting may be determined from monthly bills. When an HRA is integrated with an employer sponsored self-insured health plan, the plan sponsor need only report on the self-funded health plan information.

How does the employer/plan sponsor pay the fee to the IRS?

Employers complete and file the Form 720 for the second quarter. The Form 720 and fees are due on July 31 of the calendar year following the last day of the plan year. Your Form 720 with applicable fee is due by July 31, 2023 for plan years ending in 2022.

For additional information click here.

 

How much is the PCORI fee?

The amount of the PCORI fee is equal to the average number of lives covered during the policy or plan year multiplied by the dollar amount for the year (determined by the plan-year ending month).

  • For plan years ending before October 1, 2022, the applicable fee is $2.79 for each covered life.
  • For plan years ending on or after October 1, 2022, the applicable fee is $3.00 for each covered life.

How are “lives” defined?

For self-insured plans, covered lives include participating employees and dependents.

 

For groups participating in CBIA’s Fixed Funding Solutions self-insured plan. A report is available here to assist with calculating your average life count. Find the link to the report in the left-hand navigation bar, titled PCORI-Monthly Member Counts.
Complete the registration for online account access form if you need access to the secure employer site.

For HRA and health FSA plans, only participating employees are counted as covered lives. Plan sponsors can use their monthly bills to determine this number.

 

Important information and the 2023 Form 720 and instructions are available on the IRS website