PCORI Fees Due July 31, 2023

The Affordable Care Act (ACA) imposes a fee on self-funded plan sponsors and health insurance issuers known widely as Patient-Centered Outcomes Research Institute (PCORI) fees. This is also sometimes referred to as the Comparative Effectiveness Research Fees, or CERF. These fees were originally applicable for plan years ending between October 1, 2012 and September 30, 2019. However, in 2019 the PCORI fees were extended for an additional 10 years.

The PCORI fee is reported and paid annually on IRS Form 720. These fees are due July 31 of each year for the plan year that ended in the prior calendar year. Therefore, the deadline for filing Form 720 is July 31, 2023, for all plan years that ended in 2022.

The fee is based on the average number of lives covered by the plan multiplied by the applicable fee.

• For plan years that ended up to, and including, 9/30/22, the fee is $2.79 multiplied by the average number of covered lives.
• For plan years that ended between 10/1/22 and 12/31/22, the fee is $3.00 multiplied by the average number of covered lives.

Self-funded plan sponsors and health insurance issuers are to calculate the average number of covered lives using one of the following permissible methods:

• Actual count method
• Snapshot method
• Form 5500 method (applicable only to self-funded plan sponsors)
• Member months method (applicable only to health insurance issuers)
• State form method (applicable only to health insurance issuers)

If you have questions about how to calculate the average number of covered lives, which plans need to be reported, or any other questions regarding PCORI fees, please contact your Hylant representative.

Reach out to your Hylant representative for further information. Don’t have one? Contact us here.

The above information does not constitute advice. Always contact your employee benefits broker or trusted advisor for insurance-related questions.