The Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks and benefits of medical treatments. The fees were originally scheduled to be collected for plan years and policy years that end after September 30, 2012 and before October 1, 2019.  In a bill recently signed by the President, the PCORI  fee has been extended through fiscal year 2029.  All non-excepted employer sponsored health plans need to pay PCORI fees by July 31st.

If the plan is fully insured, the carrier is responsible for paying the fee. If the plan is self-funded / level-funded, the plan sponsor (i.e. the employer) is responsible for paying the fee. If you are sponsoring a self-funded group health plan, your carrier or TPA may provide you with the data needed to pay the PCORI fee. In addition, the employer may be responsible for reporting and paying the PCORI fee if you maintain a self-funded group health plan and/or an HRA in conjunction with a fully insured health plan or if you maintain any non-excepted employer sponsored health plan.

Health Reimbursement Arrangements (HRAs) are considered self-funded health plans and are subject to the PCORI fee. However, special rules apply to HRAs for purposes of calculating the PCORI fee:

  • If the plan sponsor also maintains a self-funded medical plan with the same plan year, the medical plan and HRA may be treated as one plan for purposes of the PCORI fee. However, if the medical plan is fully insured, the medical plan and HRA must be treated as separate plans for purposes of the PCORI fee, with the insurer paying the fee for the medical plan and the employer/plan sponsor paying the fee for the HRA.
  • For purposes of counting covered lives for HRAs, only employees need to be counted; spouses/dependents are not included.

The fee amount depends on when the self-funded contract year ended. Please refer to the following chart (to be updated by the IRS) for the filing due date and applicable rate depending upon the month a specified health insurance policy or an applicable self-insured health plan ends.

The fee is calculated based on the *average number of lives covered under the plan (including employees, dependents, COBRA participants, and covered retirees) and is due by July 31 following the end of each applicable year.  The fee must be paid and reported using the revised Form 720  for more information see Part II, page 8-9 of the instructions (PDF).

*For more information and instructions for determining average number of lives covered.

Answers to Frequently Asked Questions

Applicable Types of Coverage