For those that have a medical plan with an HRA and/or are self-funded, this is a reminder your 2020 PCORI fee is due July 31, 2021.
Who Does This Apply To?
The entity responsible for paying the PCORI fee depends on whether the plan is insured or self-insured.
- For fully insured health plans, the issuer of the health insurance policy is required to pay the fees.
- For self-insured health plans, the fees are to be paid by the plan sponsor. Self-insured health plans include traditional self-funded plans, level-funded self-funded plans (which include, but are not limited to, UHC All Savers, PreferredOne's Simplicity Product, Spaggregate level-funded, HealthPartners Assure or Balance plans, Alliana/Aetna Funding Advantage, BCBS BlueFlex, Medica Maximum Liability, etc.), as well as health reimbursement accounts attached to your health plan.
When in question, please contact your North Risk Partners Risk Advisor.
What is a PCORI fee?
The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute (PCORI) to help patients, clinicians, payers and the public make informed health decisions by advancing comparative effectiveness research.
The institute’s research is to be funded, in part, by fees paid by health insurance issuers and sponsors of self-insured health plans. These fees are widely known as Patient-Centered Outcomes Research Institute fees (PCORI fees), although they may also be called PCOR fees or comparative effectiveness research (CER) fees.
We strongly advise you take the time to read through North Risk's Compliance Overview on PCORI Fees*. Directly below, you will find a PCORI fee payment schedule based on plan year start date. For easy reference, we’ve also included links to relevant forms and documents below. If you require assistance determining your member counts for your 2020 plan year, please contact your North Risk Partners' representative.
|Plan Year||Fee Per Average Covered Life||Due Date|
|2/1/19 – 1/31/20||$2.54||July 31, 2021|
|3/1/19 – 2/28/20||$2.54||July 31, 2021|
|4/1/19 – 3/31/20||$2.54||July 31, 2021|
|5/1/19 – 4/30/20||$2.54||July 31, 2021|
|6/1/19 – 5/31/20||$2.54||July 31, 2021|
|7/1/19 – 6/30/20||$2.54||July 31, 2021|
|8/1/19 – 7/31/20||$2.54||July 31, 2021|
|9/1/19 – 8/31/20||$2.54||July 31, 2021|
|10/1/19 – 9/30/20||$2.54||July 31, 2021|
|11/1/19 – 10/31/20||$2.66||July 31, 2021|
|12/1/19 – 11/30/20||$2.66||July 31, 2021|
|1/1/20 – 12/31/20||$2.66||July 31, 2021|
If you have questions related to this update, please contact your North Risk Partners advisor. Don’t have an advisor? No problem. We’ll help you find one.
This regulatory update is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
*Downloadable content is reserved for North Risk Partners clients. Zywave Client Portal login credentials are needed to download the bulletin.