The annual deadline to report and pay the Patient-Centered Outcomes Research Institute (PCORI) fee is fast approaching. Employers sponsoring certain self-funded health plans must take action by July 31, 2025, to comply with this IRS requirement.
What is the PCORI Fee?
The PCORI fee helps fund research that evaluates the effectiveness of medical treatments and services. It applies to most health plans, including:
Fully insured plans are generally excluded from the fee since insurance carriers handle payment, but employers with self-insured components or stand-alone HRAs may still have reporting obligations.
What HR Teams Must Do:
If your organization sponsors a self-insured or level-funded health plan, you must:
Fee Amount (Based on Plan Year Ending Dates)
How to Calculate the Fee
You can choose one of these IRS-approved methods to determine the average number of covered lives for your plan:
Count covered lives (employees, spouses, dependents) on each day of the plan year and divide by the total number of days.
Count covered lives on designated days (e.g., first day of each quarter or month) and average those numbers.
Use participant counts from your most recent Form 5500 filing, adding dependents as specified.
Employers can select the method that is most practical for their circumstances, but consistent application is required.
How to Report and Pay
Next Steps for HR
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This article is for informational purposes only and is not intended as legal, tax, or benefits advice. Readers should not rely on this information for taking (or not taking) any action relating to employment, compliance, or benefits. Always consult with a qualified professional before making decisions based on this content.