PCORI Fee Calculation & Filing Assistance
If your organization is self-insured and/or has a Health Reimbursement Account (HRA) plan or non-excepted Flexible Spending Account (FSA) plan, you are required to pay the new Patient-Centered Outcomes Research Institute (PCORI) fee directly to the IRS.
Kelly Benefits has partnered with MZQ Consulting to help service our clients who maintain self-insured plans or offer HRAs. The Kelly Benefits/MZQ PCORI Service will:
- Evaluate enrollment data to determine the most cost-efficient reporting method.
- Provide a signature-ready Form 720 and filing instructions.
The $150 MZQ fee for this service will be directly billed through Kelly Benefits.
PLEASE NOTE ALL PCORI SERVICE REQUESTS MUST BE RECEIVED BY NO LATER THAN JULY 22nd IN ORDER TO ENSURE TIMELY DELIVERY
The Patient Protection and Affordable Care Act imposes a new Patient-Centered Outcomes Research Institute (PCORI) fee on plan sponsors and issuers of individual and group policies. The PCORI fee is adjusted to reflect inflation in National Health Expenditures annually.
For some of our clients, this PCORI fee filing will need to be completed by July 31. For a copy of the fee schedule to see exactly when your company needs to file, please CLICK HERE.
As the plan sponsor, self-funded employers must complete Form 720 and pay the PCORI fee directly to the IRS. Also, any fully-insured employer with a Health Reimbursement Account (HRA) plan or non-excepted Flexible Spending Account (FSA) plan will need to pay the fee directly to the IRS for any employees participating in the offered HRA or FSA. In some instances this could mean that a fully-insured employer with an HRA plan would be required to pay a PCORI fee both through their insurer and directly to the IRS. This is a new clarification in the PCORI statutes that many were not anticipating.
For fully-insured employers that do not offer HRA plans, issuers (carriers) are responsible for filing Form 720 and paying the required PCORI fee on their behalf. This fee will be rolled into the premium.
For self-funded employers or fully-insured employers without an HRA plan the annual PCORI fee is equal to the average number of covered lives (including dependents and spouses) for an employer’s policy year times the applicable dollar amount.
For fully-insured employers with an HRA plan or non-excepted FSA plan, the annual PCORI fee is equal to the average number of employees covered (excluding dependents and spouses) under the offered HRA or FSA plan(s) for an employer’s policy year times the applicable dollar amount.
The final regulations require:
Plan sponsors (i.e., employers) of applicable health plans (i.e., self-funded plans or plans offering HRAs and/or non-excepted FSAs) to use one of three alternative methods — the actual count method, the snapshot method or the Form 5500 method — to determine the average number of lives covered under the applicable self-insured health plan for a plan year in order to calculate the fee owed.
Issuers (i.e., carriers) of specified health insurance policies (i.e., fully-insured plans) to use one of four alternative methods — the actual count method, the snapshot method, the member months method or the state form method — to determine the average number of lives covered under a specified health insurance policy for a policy year in order to calculate the fee owed.
To learn more about this service, or the PCORI
fee, please contact your Kelly Benefits Broker
or MZQ Consulting at 443-948-6800