Smart Benefits: IRS Sets PCORI Fees for 2017

Rob Calise, GoLocalProv Business/Health Expert

Smart Benefits: IRS Sets PCORI Fees for 2017

The IRS recently announced that the Patient-Centered Outcomes Research Institute (PCORI) fee, imposed on health insurers and plan sponsors of self-insured group health plans, will increase to $2.26 per covered life for plan years that end on or after October 1, 2016, and before October 1, 2017, up from $2.17 for the previous year.

The ACA created the fee to pay for research on the clinical effectiveness of medical procedures. It is assessed for each plan year ending after September 30, 2012 and before October 1, 2019.

All plan sponsors of self-insured group health plans will pay the PCORI fee in 2017, but the amount of the fee will depend on when the plan year ends:

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Insurers are responsible for calculating and paying the fee for fully-insured plans. For self-insured health plans, however, the employer sponsor is responsible for calculating and paying the fee. Payment is made by filing Form 720 by July 31 following the end of the calendar year in which the health plan year ends.

An HRA that is bundled with a fully-insured medical plan is subject to a separate fee. Although the insurer pays the fee for the underlying insured medical plan, the plan sponsor must pay a separate PCORI fee for the self-insured HRA. However, an HRA that is bundled with, and has the same plan year as, a self-insured major medical plan is not subject to a separate fee.

PCORI sunsets in 2019, so no fee will apply for plan years ending after September 30, 2019. That means that for a calendar year plan, the last assessment will be for the 2018 calendar year.

 

Rob Calise is the Managing Director, Employee Benefits. of Cornerstone|Gencorp, where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.

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