Understanding PCORI Fees Key Questions

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How well do you understand PCORI fees?

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Wednesday Wisdom

United States

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Understanding PCORI Fees Key Questions


Understanding PCORI Fees Key QuestionsOnline version How well do you understand PCORI fees? by Wednesday Wisdom 1 Patient Centered Outcomes Research Institute (PCORI) fees apply in the following situations: a an employer with a level-funded plan b an employer with a self-insured dental plan c an employer with a health reimbursement arrangement(HRA) that reimburses medical travel only d All of the above e A and C only 2 An employer with a self-insured medical plan with an HRA will have to pay a PCORI fee on the self-insured plan and also on the HRA. a True - if the HRA doesn't have the same plan year as the medical plan b False - an employer when offering both never has an obligation to pay PCORI on the HRA, only for the self-insured plan c True - only if it's a specialty HRA 3 The PCORI fee for a fully insured plan is built into the insurance premium, so the carrier will pay the PCORI fee when the plan is fully insured. There is no action required by the employer. a True b False 4 Does the PCORI fee apply to an HRA? a Yes - an HRA is a self-insured health plan. b No - if an HRA (e.g., Maven & Carrot plans) doesn't cover a wide range of medical services (e.g., only used for fertility benefits) they are excepted benefits 5 PPs Inc changed from fully insured to level funded at renewal, on August 1, 2024 for their 8/1/2024 - 7/31/2025 ERISA plan year. PPs will have a PCORI fee obligation due this year by 7/31/2026. a True b False 6 LA LLC started a Maven Fertility Program 7/1/25 for their 7/1/25 - 6/30/26 ERISA plan year. LA LLC will have a PCORI filing due this year by 7/31/2026. a True. b False - specialty HRAs are not subject to PCORI fees c False. Their PCORI fee filing is due 7/31/2027 7 If an employer has an HRA paired with a fully-insured medical plan. The HRA PCORI fee paid by the employer is: a determined by counting the number of participants (employees & dependents) in the HRA b determined by counting only one life per employee participating in the HRA (and not dependents) c determined by looking at the number of participants reported on the Form 5500 for the plan year d not required. The carrier will pay the PCORI fee for all participants on the major medical plan which are the same participants on the HRA 8 Plan sponsors can use any of the following methods to calculate covered lives: a Actual Count Method, Snapshot Method, Form 5500 Method b Actual Count Method, Average Dependents Method, Form 5500 method c Average Dependents Method, Snapshot Method, Form 5500 Method d Actual Count Method, Average Dependents Method, Form 5500 method. 9 The PCORI fee can be filed on any quarter Form 720. a True b False

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Understanding PCORI Fees Key Questions

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Understanding PCORI Fees Key QuestionsOnline version

by Wednesday Wisdom

Patient Centered Outcomes Research Institute (PCORI) fees apply in the following situations:

An employer with a self-insured medical plan with an HRA will have to pay a PCORI fee on the self-insured plan and also on the HRA.

The PCORI fee for a fully insured plan is built into the insurance premium, so the carrier will pay the PCORI fee when the plan is fully insured. There is no action required by the employer.

Does the PCORI fee apply to an HRA?

PPs Inc changed from fully insured to level funded at renewal, on August 1, 2024 for their 8/1/2024 - 7/31/2025 ERISA plan year. PPs will have a PCORI fee obligation due this year by 7/31/2026.

LA LLC started a Maven Fertility Program 7/1/25 for their 7/1/25 - 6/30/26 ERISA plan year. LA LLC will have a PCORI filing due this year by 7/31/2026.

If an employer has an HRA paired with a fully-insured medical plan. The HRA PCORI fee paid by the employer is:

Plan sponsors can use any of the following methods to calculate covered lives:

The PCORI fee can be filed on any quarter Form 720.