PCORI Fee Amount Increase for 2023

The Internal Revenue Service (IRS) recently issued Notice 2022-59 to increase the fees paid by health plans to fund the Patient-Centered Outcomes Research Institute (PCORI).

For plan years ending on or after October 1, 2022 and before October 1, 2023, including plan years ending December 31, 2022, the updated PCORI fee amount is $3.00 multiplied by the average number of covered lives under the plan, up from $2.79 for the 2022 plan year.

What Employers Need to Know

• Self-funded plans: Employers with self-funded group health plans are responsible to file and pay the PCORI fee annually on IRS Form 720.  PCORI fees for the previous year are generally due July 31^st each year, regardless of the plan year end date (see table below for 2023 PCORI fee filing and payment deadlines).

• Fully-insured plans: Employers with fully-insured group health plans do not pay PCORI fees directly since they are already assessed this fee in their monthly premium payments by their health insurance carriers. However, certain employers with fully-insured plans may still owe the PCORI fee if they also sponsor a Health Care FSA or HRA (see below for more information).

PCORI Fee Background

The PCORI fee is a requirement under the Affordable Care Act to fund the Patient-Centered Outcomes Research Institute, focusing on clinical effectiveness research.  It was scheduled to end for plan years ending on or after October 1, 2019.  However, a federal spending bill passed by Congress in 2019 reinstated the PCORI fees and filings for another ten years, through 2029.

The PCORI fee is filed and paid annually on IRS Form 720 (Quarterly Federal Excise Tax Return). Employers with self-funded health plans ending in 2022 are advised to use the 2nd quarter Form 720 to file and pay the PCORI fee by July 31, 2023. The information is reported in Part II of Form 720.

Since Form 720 is a tax form, rather than an informational return form such as Form 5500, employers or their accountants, rather than third-party administrators, must prepare and file it. The IRS permits employers to deduct PCORI fees as an ordinary and necessary business expense under IRC Section 162.

For self-funded group health plans, the fee is calculated using the average number of lives covered under the plan, including all employees and covered dependents, and the applicable rate for that plan year, outlined in the table below and also accessed on the IRS website here.

HRAs/FSAs/HSAs/Excepted Benefits

For Health Reimbursement Arrangements (HRA), the IRS outlined two special PCORI fee-related rules.  First, if the integrated medical plan is fully insured,  then the plan sponsor may treat each employee's HRA as covering a single life and is not required to include all covered lives, such as covered dependents, when reporting and paying the PCORI fee.

Second, if the integrated group health plan is self-funded, then the HRA is not subject to a separate PCORI fee as long as the HRA and the self-funded group health plan have the same plan sponsor and have the same plan year. In this case, one PCORI filing and fee for the self-funded group health plan is due, based on all covered lives, not just employees (as noted in the paragraph directly above).

Generally, Health Care Flexible Spending Accounts (FSAs) are not subject to PCORI fees as “excepted benefits”.  However, if an employer contributes to an FSA that exceeds the lesser of $500 annually or a dollar-for-dollar match of the employee’s contribution, then the FSA is not considered an “excepted benefit” and is subject to PCORI fees. Similar to the HRA with a fully-insured integrated medical plan, the plan sponsor may assume one covered life for each employee with an FSA.

Health Savings Accounts (HSA) are not subject to the PCORI fee requirements since HSAs are not group health plans, but rather individual accounts.  The PCORI fee also does not apply to most dental and vision coverage since they are “excepted benefits,” exempt from PCORI fee requirements.

The IRS webpage found here contains guidance on the different types of health coverage and arrangements that are subject to the PCORI fee.

PCORI Filing and Payment Date Deadlines for 2023

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