2024 PCORI Fee Update

2023 PCORI Fee Update

Important ARPA update:

Identifying Assistance Eligible Individuals (AEIs)

and providing notices.

The U.S. Department of Labor (DOL) issued guidance under the American Rescue Plan Act of 2021 (ARPA) and provided the model notices to assist with fulfilling notice obligations for the COBRA subsidy.

We need you to identify individuals who may be subsidy eligible. There are two options, outlined below to assist you in identifying the potential AEIs.  We have provided a video and written instructions if preferred, indicating how you will update the subsidy status:

Video: How to update subsidy statuses for the American Rescue Plan Act (ARPA)

Written Instructions: How to update COBRA subsidy statuses

Option 1: HRC Total Solutions has technology available to help you identify subsidy-eligible individuals.  The QB AEI 2021 Report and import feature is available as of today.

These tools will assist you in identifying the participants in the lookback period (anyone eligible for COBRA before April 1, 2021 who may or may not have elected and/or paid for COBRA coverage but is still within their COBRA continuation period) who may be Assistance Eligible Individuals (AEIs) and updating their eligibility status.

• The report will include a column labeled AEI 2021 Status, which will default to the status of Unknown when it is initially generated.
• Complete that column with a status of Unknown, Eligible (for the subsidy), or Ineligible (for the subsidy), to update the participant record.
• Upload the completed report to the import in your employer portal.
• You can use this same process to identify subsidy-eligible individuals throughout the subsidy period.

Option 2: If you already know your subsidy-eligible population, you can:

• Gather participant data and complete the attached QB AEI 2021 Report template. Then you can import the information in the employer portal.
• You can use the existing QB Plan Members and QB Summary reports in your employer portal to gather this information and update the template.
• The first 4 columns are required and need to be completed (or left as is) in order to update the status of the participant record, including Last Name, First Name, Member ID (MID), and the AEI 2021 Status. All other columns are optional and for information purposes only.
• Upload your completed template to the import in your employer portal.
• You can use this same process to identify subsidy-eligible individuals throughout the subsidy period.
• If you are a NEWER COBRA CLIENT with HRCTS (meaning you haven’t been with HRCTS through all of the look back period) you will need to use option 2 to provide us with all the individuals that we need to notify from the look back period as HRCTS will not have all those individuals in our system so the report in Option 1 will not be complete.

Subsidy-eligible individuals are those who meet all of the following criteria: 

• Any qualified beneficiary who experienced a reduction in hours or an involuntary termination of employment.
• Has at least one medical, dental, vision, EAP, or HRA plan (not including Health FSA or QSEHRA).
• Has a Last Day of Coverage (LDOC) of April 1, 2021 or later.
• The individual must not be eligible for other group health coverage. HRCTS will collect this information from qualified beneficiaries on behalf of the employer).

Attestation

• HRCTS will include attestation information in the AEI notice unless you tell your Account Manager that you do not want it included.  
• The attestation form will have the QB attest that they are an AEI eligible individual, and they are not eligible for other group health coverage.
• They will be required to notify us if that changes during the subsidy period as well.

Next Steps

HRC Total Solutions needs the above information imported no later than May 7th in order to identify AEIs in the lookback period and mail them the required notices as outlined by the DOL.

• If you choose to notify your lookback period AEI eligible participants on your own, you do not need to take the actions outlined above. You will need to provide the DOL notice to affected participants on your own. We will redirect any affected participants back to you.
• Please notify your Account Management Team that you will not be having HRCTS send out the AEI notices.  If we do not receive the above information from you by May 7th, we will assume you will be notifying lookback period AEI eligible participants on your own.
• HRCTS will begin notifying all potential AEIs between May 14th and May 31st for all clients who have identified potential AEIs and imported the updated information into the COBRA system in order for the new AEI notice to be sent out.
• If an AEI was on a previous plan that you no longer offer, they can enroll in another plan that is offered provided the cost of the plan is the same or less than the one they were on originally, unless all the plans available through the employer now have higher premiums.
• Please make sure while entering new QBS moving forward that you are indicating under their AEI status if they are eligible or ineligible so the proper notice can be sent out to them.  You will do this for anyone that is eligible for COBRA while the subsidy is active between April 1, 2021-September 30, 2021.
• If you are using the COBRA notification form instead of entering a new QB online please use the updated form which can be found here: COBRA Notification Form
• If you have an EDI file sent to HRCTS with your COBRA information you will need to provide the AEI status for each person to the COBRA department each time a file is sent since the files do not have the status listed and this is a temporary change.  You can use the QB AEI 2021 Report template updating the 1st 5 columns (last name, first name, middle initial, AEI status, and SSN).  The report will be sent to COBRAdepartment@hrcts.com so that we may update the status for the individuals when they are entered in the system.  Not providing this spreadsheet in a timely fashion will delay notices to QBS.
• If you as the employer are providing an employer subsidy for a QB between April 1, 2021-September 30, 2021 the ARPA subsidy will replace your employer subsidy.  We will have a report of clients who have a subsidy in place for someone that is removed so that we can identify who might need the employer subsidy to start again after the ARPA subsidy has ended.

We appreciate your patience and partnership as we navigate and support these regulatory changes.  If you have any questions, please do not hesitate to reach out to your Account Management Team for assistance.

PCORI Fee Overview and Guidance

The Affordable Care Act imposes fees on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute. The fees, required to be reported annually on the 2nd quarter Form 720 and paid by its due date, July 31st, are based on the average number of lives covered under the policy or plan. The fees apply to policy or plan years ending on or after October 1, 2012, and before October 1, 2029. HRCTS will make available an Average Covered Lives Report to all clients that are responsible to file and pay the PCORI fee each year. This report will be sent to you automatically this year and you do not need to request it.

The IRS recently released the revised Form 720 that insurers and sponsors of self-insured plans will use to pay the Patient-Centered Outcomes Research Institute (PCORI) fee. The fee is due by July 31 of the year following the calendar year in which the plan/policy year ended. Sponsors of any plans that ended in 2020 must pay the 2020 fee by July 31, 2021.  Plan sponsors can now complete their planning for payment of this fee. The IRS has also confirmed health insurers and self-insured health plan sponsors can deduct PCORI fees as ordinary and necessary business expenses. The fee is based on the number of covered lives including employees, retirees and COBRA participants along with their covered dependent spouses and children are all counted. However, only the employee, retiree or COBRA participant needs to be counted for an HRA or a health flexible spending account (health FSA) -- dependents covered by these accounts can be excluded.

The types of plans that must pay the PCORI Fees by July 31, 2021 include:

• Health/accident plans
• Health Reimbursement Arrangement (HRA) plans that are not an excepted benefit (Employer contribution is greater than $500)
• Health Flexible Spending Account (FSA) plans that are not an excepted benefit (Plan has employer contributions with the maximum reimbursement greater than two times an employee’s salary reduction election or employer contribution is greater than $500)
• Retiree plans

Calculating the Fee:

The amount of the PCORI fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year.

• For plan years that end on or after October 1, 2018 and before October 1, 2019, the fee is $2.45 per covered life.
• For plan years that end on or after October 1, 2019 and before October 1, 2020, the fee is $2.54 per covered life.
• For plan years that end on or after October 1, 2020 and before October 1, 2021, the fee is $2.66 per covered life.

For policy and plan years beginning on or after Oct. 1, 2021, and before Oct. 1, 2022, the applicable dollar amount is further adjusted to reflect inflation in National Health Expenditures, as determined by the Secretary of Health and Human Services.

IRS Form 720 and Instructions:

IRS Form 720 can be accessed at http://www.irs.gov/pub/irs-pdf/f720.pdf which is an interactive document so that can be completed online.

The PCORI fees are entered on line 133 for the appropriate plans. See pages 8 - 9 of the IRS Instructions for completing these fields. Instructions can be found at http://www.irs.gov/pub/irs-pdf/i720.pdf.

Complete the fields on page 8 and make your check or money order payable to “United States Treasury”.

Additional information on the PCORI fees can be found here:
 • Patient-Centered Outcomes Research Trust Fund Fee (IRC 4375, 4376 and 4377): Questions and Answers

• An IRS chart that shows which types of benefits the fee applies to:  Application of the Patient-Centered Outcomes Research Trust Fund Fee to Common Types of Health Coverage or Arrangements

• IRS Form 720 Overview

• IRS Form 720 instructions (see pages 8 - 9)

Please Note:
 This information is provided for educational purposes only. It reflects the understanding of HRC Total Solutions and our partners using the available guidance as of the date shown and is subject to change. It is not intended to provide legal advice.  You should not act on this information without consulting legal counsel or tax advisors. (Updated April 2021)