Why Every Health Plan Needs to Be Aware of PCORI Fee Deadlines

Health care jargon explained

Understanding PCORI and its Role in Health Care

At the heart of this discussion is the definition of PCORI, which stands for Patient-Centered Outcomes Research Institute. So, what is PCORI and its purpose?

Established under the Affordable Care Act, PCORI seeks to assist patients, caregivers, and healthcare practitioners in making informed health decisions. The institute does this by funding evidence-based research, ensuring the patient remains at the center of every health care decision.

The objectives of PCORI revolve around ensuring that medical care primarily addresses the outcomes that patients deem most significant. You might ask, "What are patient outcomes examples?"  These outcomes range anywhere from reduced pain, improved mobility, decreased hospital readmissions, to better quality of life.

This influence of PCORI on health insurance plans is paramount. By emphasizing patient-oriented research and outcomes, the institute shapes the way health plans are formulated and offered, ensuring policyholders get value for their money.

PCORI and its Significance to Health Plans

PCORI plays a pivotal role in how health plans are structured and delivered. With the research and findings that PCORI offers, health plans can be better tailored to the actual needs of policyholders, ensuring they're not just affordable but also effective.

There are immense benefits to this approach. By focusing on patient-centered outcomes, policyholders are more likely to receive treatment and care that is genuinely effective and relevant to their specific needs. Furthermore, with a research institute like PCORI informing health plan decisions, there is an enhanced trust factor, knowing that the plan is based on well-researched evidence.

Importance of PCORI Fee Deadlines

The discussion on PCORI wouldn't be complete without addressing the elephant in the room: PCORI fee deadlines. Instituted by the IRS, the PCORI fee is an excise tax that health insurers and employers with HRAs, FSAs, and certain other plans must pay annually. The exact amount is adjusted annually.  

According to IRS Notice 2022-59, the current annual fees are:

  • For plan years that ended on or after Oct. 1, 2022, and before Oct. 1, 2023, (including calendar year plans), the fee is $3 per person covered by the plan, up from $2.79 a year earlier.
  • For plan years that ended on or after Oct. 1, 2021, and before Oct. 1, 2022, the fee is $2.79 per person, up from $2.66 the year before.

Because these fees are adjusted yearly, it's imperative that insurers and employers stay updated.

Miss these deadlines, and the financial implications are significant. Not only is there a monetary penalty, but the IRS takes a dim view of delayed payments. Furthermore, the consequences of not meeting these deadlines for health insurers and employers go beyond just fines; there's a reputational risk to consider.

Risks of Overlooking PCORI Filing Deadlines

With an understanding of the importance of PCORI fees, the potential risks of overlooking these deadlines become clear. Delays can result in substantial financial penalties. Additionally, an insurer's reputation is at stake. In a competitive market, where every health plan seeks to offer the best to its policyholders, being known as a firm that misses legal deadlines can be detrimental.

To compound matters, the IRS has a stringent stance on enforcing PCORI fee deadlines, making compliance non-negotiable.

Responsibility of Insurers and Employers in PCORI Fee Filing

The onus of filing and paying the PCORI fees lies squarely on the shoulders of insurers and employers. For those that offer HRAs and FSAs, or health reimbursement arrangements, it's essential to be aware of the year ending and ensure timely filings.

But who exactly is responsible? While insurers bear the brunt for insured health plans, employers sponsoring certain self-insured plans, like FSAs and HRAs, are also held accountable. And, with the IRS keenly overseeing, there's no escaping this responsibility.

However, the good news is that there are abundant resources available to assist in timely filing, ensuring that all those liable are well-equipped to meet their obligations.

Steps to Ensure Timely PCORI Fee Submission

  1. Early Preparation: Begin by understanding the exact fee applicable for the year ending. A preemptive approach will offer ample time for any adjustments needed.
  2. Stay Updated: Regularly consult the IRS website and other authoritative sources for any updates on fees or filing procedures.
  3. Use Resources: Leverage tools and guidelines provided, ensuring compliance with all stipulations.
  4. Organization: Maintain organized records of all health plans, especially if they fall under HRAs and FSAs. This makes the filing process smoother.
  5. Seek Expertise: Consider consulting tax professionals familiar with PCORI requirements. Their guidance can be invaluable.

In conclusion, while PCORI is undeniably crucial for its contribution to enhancing health care decisions, it's equally critical for health insurers and employers to be cognizant of the associated fees and filing deadlines. With due diligence, one can ensure compliance, thus offering the best to policyholders while steering clear of potential pitfalls.

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