The fee is known as the PCORI fee, named after the provision in the
recent Obamacare legislation that created the Patient-Centered Outcomes
Research Institute (PCORI). It will serve to provide
research on health care decisions, including proof of the effectiveness of
various treatments being used by health care providers.
- What plans are covered by the fee? The PCORI fee applies to all self-insured health plans except for certain limited scope dental and vision plans, most wellness programs, and most health FSA plans funded by the employee. You should be aware that HRA arrangements whereby the employer pays various medical expenses such as insurance deductibles, co-payments and co-insurance ARE subject to the fee.
- Who pays the fee? For self-insured plans the plan sponsor (employer) is responsible for paying the fee.
- How much is the PCORI fee? The fee is $2.00 for the average number of covered lives for the 2013 plan year for plan years ending on or after October 1, 2013.
- How are “covered lives” counted? There are several methods which can be used to count the average covered lives, including the actual count method, snapshot count method and the Form 5500 count method. Covered lives include any spouses or dependents, however, a special rule applies to HRAs that allows only the employee participants to be counted.
- How is the PCORI fee paid? For plan years ending on or after October 1, 2013 and before January 1, 2014, the fee will be reported on Form 720—Quarterly Federal Excise Tax Return for the 2nd quarter, which is due on or before July 31, 2014.
The discussion above provides the highlights of this new fee. If you
have any questions about whether this fee apples to your situation, or if we
can be of any further assistance, do not hesitate to contact us.
