Last Filing for Calendar Year Plans!
The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (the PCORI fee) is due by Wednesday, July 31, 2019. For calendar year plans and policies, this will be the last required PCORI filing and fee payment. For plan and policy years ending after December 31, 2018 and before October 1, 2019, one more filing and fee payment will be required (due July 31, 2020).
Internal Revenue Service (IRS) Form 720, Quarterly Federal Excise Tax Return, is still used to report and pay (in Part II, IRS No. 133) the annual PCORI fee. The filing rules have not changed, although the applicable rate has increased to $2.45 per covered life (announced via IRS Notice 2018-85).
For an insured plan, the filing obligation falls on the insurer. However, for an “applicable self-insured health plan,” the filing obligation lies with the plan sponsor. Applicable self-insured health plans include self-insured major medical coverage and health reimbursement arrangements (HRAs) for both employees and retirees, but do not include “excepted benefits” (e.g., most health flexible spending arrangements (health FSAs), standalone dental or vision plans, certain employee assistance programs (EAPs) that do not provide significant benefits in the nature medical care, etc.). The IRS provides a helpful chart to help identify the plans to which the PCORI fee applies.
The PCORI fee is currently calculated at $2.45 times the average number of lives covered for the plan year (determined using one of the IRS’s prescribed counting methods). However, for a plan year ending before October 1, 2018, the prior year’s PCORI fee rate of $2.39 will apply on this filing (and will increase to $2.45 on next year’s filing, which will be the final filing for such plan).
For example, for an employer that in 2018 sponsored an insured major medical plan (policy operated on a calendar year plan year) that was integrated with an HRA (also operated on a calendar year plan year), the insurer will have the filing obligation with respect to the average number of lives covered by major medical in 2018 (times $2.45) for the insured major medical, but the employer will also have a filing obligation with respect to the average number of lives covered by the HRA in 2018 (times $2.45), and both such filings are due July 31, 2019.
If the same employer in 2018 instead sponsored a self-insured major medical plan that was integrated with an HRA, that employer could generally treat the medical plan and HRA as a single applicable self-insured health plan for the purpose of counting the average number of covered lives (times $2.45, to determine the fee), and that filing is due July 31, 2019.