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IRS Releases Updated PCORI Fees for 2022-2023

In Notice 2023-70, the IRS provided the adjusted ACA Patient-Centered Outcomes Research Institute (PCORI) fees for plan years ending in October 2023 through September 2024. Employers who sponsor self-funded medical plans or Health Reimbursement Arrangements (HRAs) that end during 2023 are required to report and pay their PCORI fees no later than July 31, 2024.

Background

Health insurance carriers pay the fee directly in the case of fully-insured plans, so employers offering only fully-insured group health plans without any sort of HRA component do not have to do anything. However, employers and other plan sponsors are responsible for reporting and paying the fee for any self-funded group health plans, such as all Level Funded plans and all HRAs (including ‘partially self-funded’ plans, ‘deductible buy-down’ plans, and ICHRAs). While the PCORI fee applies to most group health plans, they do not apply to excepted benefits including fully compliant Flexible Spending Arrangement (FSA) supplemental health plans. For more information, an IRS chart describing the different types of plans subject to the fee can be found at https://www.irs.gov/newsroom/application-of-the-patient-centered-outcomes-research-trust-fund-fee-to-common-types-of-health-coverage-or-arrangements.

The fee is paid using quarterly excise tax IRS Form 720, Line 133, and must generally be paid no later than July 31st of the year following the last day of the plan year. If any corrections need to be made for prior years, use IRS Form 720X.

Fee Amount

Payment amounts due in 2024 will differ based on the employer’s plan year (and specifically, the plans year’s end date). The fees due in July 2024 are as follows:

• $3.00 per covered life for plan years ending in January 2023 through September 2023 (reported on IRS Form 720, Line 133(c)); and
• $3.22 per covered life for plan years ending October 2023 through December 2023 (reported on IRS Form 720, Line 133(d)). This is the same per-covered-life fee for plan years ending January 2024 through September 2024, however PCORI fees for plan years ending in 2024 are not due until Jul. 31, 2025.

The IRS maintains a chart showing applicable fee amounts based on the plan year end date, available at https://www.irs.gov/affordable-care-act/patient-centered-outreach-research-institute-filing-due-dates-and-applicable-rates. As of this writing, this chart has not yet been updated to include the applicable rates for plan years ending October 2023 through December 2023.

Calculating the Average Covered Lives

Self-funded plans may use one of five methods to determine the average covered lives used for reporting and paying the PCORI fee: (i) the actual count method; (ii) the snapshot count method; (iii) the snapshot factor method; or (iv) the Form 5500 method. There are special rules that apply for employers offering multiple self-funded plans or an HRA integrated with a fully-insured plan.

• Multiple Self-Funded Plans – If one plan sponsor maintains more than one self-funded health plan with the same plan year, the arrangements can be treated as a single plan for purposes of the fee.
• HRAs (including ‘partially self-funded’ plans and ‘deductible buy-down’ plans) – An employer who sponsors an HRA integrated with a fully-insured medical plan is required to pay the fee only with respect to each HRA participant/employee (not required to count dependents or beneficiaries).

Summary

Those who sponsor self-funded health plans and/or HRAs with plan years ending during the 2023 calendar year should prepare to submit PCORI fees no later than Jul. 31, 2024. Each year is a little different, but typically the fees and dates are not updated on the Q2 IRS Form 720 until the end of April or beginning of May each year.

Notice 2023-70 can be found at https://www.irs.gov/pub/irs-drop/n-23-70.pdf. A general summary of PCORI fee requirements can be found at https://www.irs.gov/newsroom/patient-centered-outcomes-research-institute-fee.

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