PCORI Fee Deadline Looms For Self-Insured Health Plans


The Patient Centered Outcome Research Institute was created under the Affordable Care Act to "promote the use of evidence-based medicine by disseminating comparative clinical effectiveness research findings." The Institute is funded by a fee (the PCORI fee) assessed on the plan sponsor (generally the employer) of applicable self-insured health plans and by issuers of specified insurance policies. This alert addresses the PCORI fee owed by sponsors of self-insured plans. The fee is in effect for plan years ending on/after October 1, 2012 and before October 1, 2019.

Types of Plan Affected. The applicable self-insured health plans on which the PCORI fee is based are plans providing accident and health coverage where any part of the coverage is not provided by an insurance policy. Note that if a plan is partially self-insured and partially insured, the employer must treat the non-insured portion as a self-insured plan for purposes of the fee. Affected plans include: major medical plans, prescription drug plans, retiree plans and dental/vision/HRA/FSA plans that are not excepted from HIPAA. Plans excluded from the fee are: excepted benefits under HIPAA (such as stand alone dental and visions plans and certain HRA and FSA plans), HSAs, plans primarily covering ex-patriots,and wellness/EAPs if the plan does not provide significant benefits in the nature of medical care.

Please see full Alert below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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