The Patient-Centered Outcomes Research Institute (PCORI) fee is an ACA fee that helps fund research regarding the effectiveness of medical treatments so that patients, clinicians, purchasers, and policy-makers can make informed health decisions. The PCORI fee applies to plan years ending on or after 10/1/2012 and before 10/1/2019.
Who is responsible for paying the PCORI fee?
- Self-insured health plans: Issuers of specific health insurance policies, as well as plan sponsors of applicable self-insured health plans are required to report and pay the PCORI fee.
- Fully-insured health plans with no HRA: The health insurance carrier is responsible for reporting and paying the PCORI fee.
- Fully-insured health plans with HRA: Employers with fully-insured plans that also sponsor a separate medical HRA must pay the PCORI fee for the HRA, while the insurer pays the fee for the fully-insured plan. In this situation, the underlying fully-insured plan and the HRA are treated separately with respect to the PCORI fee.
What types of health plans are subject to the PCORI fee?
Please refer to the IRS chart on what types of insurance coverage are subject to the PCORI fee. Additionally, the PCORI fee only applies to plans that cover individuals residing in the United States.
How much is the PCORI fee?
The fee has recently increased and will continue to increase on an annual basis due to inflation. For plan years ending on or after 10/1/2017 and before 10/1/2018, the applicable dollar amount is $2.39.
When is the Deadline?
The PCORI fee must be paid using Form 720, Quarterly Federal Excise Tax Return. The deadline for filing Form 720, as well as for payment, is July 31 of the year following the year in which the plan ended. As such, this fee will not be due again until July 31, 2018.
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