Reminder! PCORI Fee Due July 31

Employers who sponsored self-funded medical plans that ended sometime during 2023 are required to report and pay the ACA Patient-Centered Outcomes Research Institute (PCORI) fees no later than July 31, 2024. Fully insured plan sponsors can rely on their carriers to submit the fee on their behalf, but fully insured plan sponsors that sponsor a self-funded plan component such as a health reimbursement arrangement (HRA) or a flexible spending account (FSA) will need to file and pay for the self-funded component plan.

Payment amounts due in 2024 will differ based on the employer’s plan year. The IRS put together a chart showing applicable fee amounts depending on the plan’s year end date. The fees due in July 2024 are as follows:

• $3.00 per covered life for plan years ending after September 30, 2022, and before October 1, 2023
• $3.22 per covered life for plan years ending after September 30, 2023, and before October 1, 2024

Self-funded plans may use one of three methods to determine the average covered lives used for reporting and paying the PCORI fee: (i) the actual count method; (ii) the snapshot method; or (iii) the Form 5500 method. There are special counting rules that apply to employers offering multiple self-funded plans or a health reimbursement arrangement (HRA) integrated with a fully insured plan. For more information on these methods to determine the average number of lives covered under a policy for the policy year, please see the IRS final regulations (PDF).

The PCORI fee count and payment are submitted using the IRS Form 720.

Reminder! Form 5500 Due July 31 for Calendar Year Plans

Employee health and welfare plan administrators with at least 100 participants must file an IRS Form 5500 each year by the last day of the seventh month after the end of the plan year. This means plan sponsors with calendar year plans must file annually by July 31.

Plan sponsors may file an extension, which delays the annual filing deadline for calendar year plans to October 15. Get more information about filing Form 5500.

Support for QualChoice Members Impacted by Recent Tornadoes

Effective May 26, 2024, QualChoice is suspending policy cancellations and non-renewals for 60 days due to unpaid premiums. The suspension is not automatic. To be considered eligible you must:

• Contact Member Services at 1-800-235-7111 (TTY: 711) to request this suspension.
• Have suffered significant property damage, injuries, or related loss of life as a result of the severe storms occurring between May 24, 2024, through May 26, 2024.

Call Member Services at 1-800-235-7111 (TTY: 711) if you need to:

• Get an emergency prescription refill.
• Replace necessary medical equipment, services, or supplies.
• Get a new copy of your QualChoice Member ID card.
• Speak with a registered nurse, 24 hours a day, seven days a week.
• Find a doctor in your area.
• Get help dealing with stress or depression.

Additional Resources

Big Savings Aren’t Just for Big Companies 

Level Funding plans offer relief for employers with 10–100 enrolled subscribers. 

Level Funding Features 

• Refund at the end of plan year if claims are lower than funded 
• Stop-loss insurance to manage risk from higher-than-expected claims 
• Predictable payments — same amount each month 
• Broad array of plan designs to choose from 
• Exempt from some Affordable Care Act taxes, fees, and penalties

How It Works 

• You pay a monthly fee, which is made up of: 
• An estimated claims amount based on the health of your employees 
• An administration fee, which covers the cost of claims payment, care management, and broker commission 
• A stop-loss premium covering the cost of insurance on higher-than-expected claims (PCORI applies)

QualChoice Level Funding Plan Options (PDF)

If you would like to learn more about QualChoice Level-funding for group health plans, contact your Sales Account Manager or Account Service Representative (PDF) for more information.

Holiday Closures

Our offices will be closed on Wednesday, June 19, and Thursday, July 4, in observance of the Juneteenth and Independence Day holidays.