PCORI Fees Announced for 2023 for Self-Insured Health Plans
Patient-Centered Outcomes Research Institute (PCORI) Fees Updated by IRS
On November 14, 2022, the IRS released Notice 2022-59 which updated the amount of the Patient-Centered Outcomes Research Trust Fund fee that self-insured health plans must pay for plan years ending on or after October 1, 2022, and before October 1, 2023.
The applicable dollar amount for plan years ending on or after October 1, 2022, and before October 1, 2023, is $3.00. This is a .21 increase from the $2.79 rate in 2022.
Fees are reported and paid annually with the submission of IRS Form 720 (Quarterly Federal Excise Tax Return).
What are PCORI Fees?
Under the Affordable Care Act (ACA), most employer sponsors and insurers are required to pay PCORI fees until 2029, as it applies to plan years ending on or before September 30, 2029.
The PCORI fee imposed on sponsors of a self-insured health plan is based on the average number of lives covered under the plan. That means plan sponsors must account for all parties enrolled in their respective plan- including dependents, spouses, retirees, and COBRA beneficiaries.
The PCORI fee is paid annually and is due on July 31st. Fees are due on July 31 of the year following the last day of policy or plan year.
Employers that sponsor self-insured group health plans must report and pay PCORI fees using the newly released (Rev. June 2021) IRS Form 720, Quarterly Federal Excise Tax Return. The IRS states that the fee should be paid using the Electronic Federal Tax Payment Systems (EFTPS).
PCORI stands for Patient-Centered Outcomes Research Institute and is federally funded organization that was established through the 2010 Patient Protection and Affordable Care Act.
PCORI fees were originally slated to end in 2020, but under the Further Consolidated Appropriations Act of 2020, signed into law on December 20, 2019, PCORI fees were extended for another 10 years.
As a result of this extension, the Patient-Centered Outcomes Research Trust Fund fee will continue to be imposed through 2029.
What does this mean for Difference Card Employer Groups?
Difference Card Employer Groups should pay the tax for all employees covered in self-funded plans like The Difference Card.
Your Health Insurance Carrier is responsible for paying the tax on underlying plans that are fully insured. You will only be responsible for paying the tax once per year based on your Difference Card covered lives.
For plan years ending on or after October 1, 2021, and before October 1, 2022, the tax is equal to $2.79 times the number of covered employees.
For plan years ending on or after October 1, 2022, and before October 1, 2023, the tax is equal to $3.00 times the number of covered employees.
We’re happy to answer any questions!
If you have any questions about your Difference Card covered lives, please contact your Difference Card Account Manager. Your Difference Card Account Manager can provide a report detailing covered lives your Difference Card Plan to assist in your filing.
Please note, the PCORI tax is a part of the excise tax provisions of the Internal Revenue Code. The Difference Card does not provide legal or tax advice and recommends that you discuss all related items with your company finance advisor.