The Patient-Centered Outcomes Research Institute (PCORI) fee for plan years ending on and after January 1, 2018 and on and before December 31, 2018 must be remitted to the IRS by July 31, 2019. The PCORI fee for plan years ending on or after October 1, 2018 and before October 1, 2019, including 2018 calendar year plans, is $2.45 per person covered under the applicable health plan, up from $2.39 for the previous plan year. The amount of the fee due will vary, depending on when in 2018 the payer’s plan year ended.
The Affordable Care Act (ACA) created PCORI to help patients, clinicians, payers and the public make more informed health decisions by advancing comparative effectiveness research. The Institute’s research is funded, in part, through PCORI fees paid by insurers of “specified health insurance policies” and plan sponsors of self-insured health plans. Plan sponsors of self-insured health plans are required to pay the PCORI fee for certain health coverage arrangements. Plan sponsors of fully-insured health plans are not responsible for paying the PCORI fee (the obligation rests with the insurer). For a list of insurance coverage or arrangements subject to the PCORI fee, please see the IRS chart.
The IRS has published the PCORI Filing Due Dates and Applicable Rates chart to assist insurers and plan sponsors with determining the applicable fee and due date based on the end date of a policy/plan year. The filing and remittance process to the IRS is largely unchanged from last year. The PCORI fee is paid using IRS Form 720 Quarterly Federal Excise Tax Return and the payment can be made through the Electronic Federal Tax Payment System (EFTPS). When completing the payment voucher (720-V), the tax period for the fee should indicate “2nd Quarter.” This quarter designation is an essential step in the reporting processes, as failure to properly designate “2nd Quarter” on the voucher may trigger a tardy filing notice from the IRS. Detailed guidance regarding how to calculate, report, and pay the fee is also provided on the IRS PCORI fee webpage.
Under the ACA, self-insured health plan sponsors and health insurers must pay PCORI fees for plan or policy years ending on or after October 1, 2012 and before October 1, 2019. So the PCORI fee will not be assessed for plan years ending after September 30, 2019. Thus, for a calendar year plan, the last year for assessment is the 2018 calendar year. The final filing will be due July 31, 2019 for a calendar year plan year ending December 31, 2018. And for non-calendar year plans that end between January 1, 2019 and September 30, 3019, there will be one last PCORI payment due by July 31, 2020.