This blog post was authored by Heather DeBlanc
The Affordable Care Act implemented a new fee called the Patient-Centered Outcomes Research Trust Fund, or “PCOR” fee. For the most part, health insurance issuers, rather than employers, are responsible for paying the PCOR fee. However, the fee also applies to self-insured plan sponsors and must be paid by employers, including public agencies, which sponsor applicable self-insured health plans. Below are answers to several commonly posed questions:
What is the PCOR fee? – The PCOR fee helps to fund the Patient-Centered Outcomes Research Institute (“PCORI”). According to the IRS, the mission of this research institute is to “assist patients, clinicians, purchasers and policy-makers in making informed health decisions by advancing the quality and relevance of evidence-based medicine. The institute will compile and distribute comparative clinical effectiveness research findings.”
Who has to pay the PCOR fee? – The PCOR fee applies to two groups: (1) Issuers of specified health insurance policies and (2) plan sponsors of applicable self-insured health plans. They must pay the PCOR fee each year for plan years ending after Sept. 30, 2012, and before Oct. 1, 2019. Self-insured plans that provide only excepted benefits (such as stand-alone vision and dental) are not subject to the PCOR fee. Furthermore, self-insured plans that are limited to employee assistance programs, disease management programs or wellness programs are not subject to the PCOR fee unless the program provides significant medical care or treatment benefits.
Are non-profits or public agencies exempt? – No. However, a self-insured health plan is exempt if it provides only excepted benefits or is an exempt governmental program (limited to Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and federal Armed Forces/Indian tribe programs). The IRS has provided a chart with additional information at http://www.irs.gov/uac/Application-of-the-Patient-Centered-Outcomes-Research-Trust-Fund-Fee-to-Common-Types-of-Health-Coverage-or-Arrangements.
How much is the PCOR fee? – The amount of the PCOR fee is equal to the average number of lives covered during the plan year multiplied by the applicable dollar amount for the year. The applicable amount varies based on plan year, but starts at $1 for plan years ending after Sept. 30, 2012 and before Oct. 1, 2013. More information is available at http://www.gpo.gov/fdsys/pkg/FR-2012-12-06/pdf/2012-29325.pdf.
When is the PCOR fee due? – Payment of the fee is due on July 31 of the year following the last day of the plan year to which the fee applies, which means payment of the PCOR fee will be due July 31, 2013 for plan sponsors with calendar year self-insured health plans, and for certain fiscal year plans.
How do I pay the PCOR fee? – The fee should be paid in conjunction with filing IRS Form 720 “Quarterly Federal Excise Tax Return.” Issuers and plan sponsors who are required to pay the PCOR fee but are not required to report any other liabilities on a Form 720 only have to file Form 720 once per year, and will not be required to file quarterly. Form 720 is available at http://www.irs.gov/pub/irs-pdf/f720.pdf.