Application of the Patient-Centered Outcomes Research Trust Fund Fee to Common Types of Health Coverage or Arrangements

Military health plans (programs established by Federal law for providing medical care (other than through insurance policies) to individuals (spouses or dependents) by reason of the individual being (or having been) a member of the Armed Forces of the United States)

Certain Indian tribal government health plans (programs established by Federal law for providing medical care (other than through insurance policies) to members of Indian tribes (as defined in section 4(d) of the Indian Health Care Improvement Act))

Health Savings Arrangements (HSAs)

Archer Medical Savings Accounts (MSAs)

Hospital indemnity or specified illness benefits

Stop-loss or indemnity reinsurance

Employee assistance programs, disease management programs, or wellness programs

No, provided the program does not provide significant benefits in the nature of medical care or treatment

Accident-only coverage (including accidental death and dismemberment)

Disability income coverage

Automobile medical payment coverage

Workers’ compensation or similar coverage

On-site medical clinic

Special rule for coverage under multiple applicable self-insured health plans:

• Generally, separate fees apply for lives covered by each specified health insurance policy or applicable self-insured health plan.
• However, two or more applicable self-insured health plans may be combined and treated as a single applicable self-insured health plan for purposes of calculating the PCORI fee but only if the plans have:
  • The same plan sponsor; and
  • The same plan year.

  For example, if amounts in an HRA may be used to pay deductibles and copays under a specified health insurance policy, the HRA (an applicable self-insured health plan) and the policy would be subject to separate PCORI fees. However, an HRA that may be used to pay deductibles and copays under the applicable self-insured health plan is not subject to a separate fee (and the fee will apply only to the applicable self-insured health plan) if both the HRA and the applicable self-insured health plan have the same plan sponsor and the same plan year.

  • There is no similar rule for lives covered by more than one insurance policy subject to the PCORI fee.

  Special counting rule for HRAs and FSAs:

  • Plan sponsors are permitted to assume one covered life for each employee with an HRA.
  • Plan sponsors are permitted to assume one covered life for each employee with an FSA.