The Affordable Care Act created the Patient-Centered Outcomes Research Institute (PCORI) to improve the quality of health care and provide information to help consumers make informed health care decisions. Most health plans must pay an annual fee to fund PCORI research. An exception is made for stand-alone dental or vision plans, EAPs, wellness programs, plans for employees outside of the U.S., HSAs, and almost all HRAs and FSAs. Click here for a chart explaining the types of plans that must pay the PCORI fee. The next PCORI fee is due July 31, 2018.
If a health plan is fully insured, the insurer is responsible for paying the PCORI fee. If the health plan is self-funded, the plan sponsor (employer) must pay the fee.
A self-funded health plan determines the applicable fee by multiplying the fee amount by the average number of total lives covered by the plan.
The rules allow employers with self-funded plans to select among three methods for determining the number of covered lives.
Insurers may select among four methods for determining the number of covered lives.
The fee is paid for a completed plan year. The amount due for Plan Years ending on or after 10/1/2016 and before 10/1/2017 is $2.26 per covered life. The amount due for Plan Years ending on or after 10/1/2017 and before 10/1/2018 is $2.39 per covered life.
A self funded plan pays the PCORI fee by filing IRS form 720.