Annual PCORI Fee Reporting
PCORI Fee Overview: What You Need to Know
The Affordable Care Act (ACA) requires issuers of certain health insurance policies and sponsors of applicable self-insured health plans to pay a fee that funds the Patient-Centered Outcomes Research Institute (PCORI). This institute enhances clinical effectiveness research to help make better-informed healthcare choices.
Annual Reporting & Due Date
The PCORI fee is reported once a year and is due by July 31 following the end of the policy or plan year. It is calculated based on the average number of lives covered under the policy or plan.
Fee Responsibility
- Self-insured medical plans, Flexible Spending Accounts (FSAs), and Health Reimbursement Arrangements (HRAs) are responsible for the fee, except for plans primarily for employees residing outside the U.S. or plans that are considered excepted benefits.
- Insurers pay the fee for fully insured plans.
CBIA Fixed Funding Solutions Compliance
Customers are required to file IRS Form 720 and remit the fee directly. Our secure website provides a report to aid in this filing—locate it in the left-hand navigation bar, labeled “PCORI-Monthly Member Counts.” If you need access to the secure employer site, please submit the online account access registration form.
HRA Compliance for Fully-Insured Plans
Employers with an HRA integrated into a fully-insured plan must file Form 720 and pay the fee themselves. Monthly billing statements can be used to gather the necessary data. When an HRA is paired with a self-insured health plan, only the self-funded health plan information needs to be reported.
Payment Submission Process
Employers must complete and submit Form 720 for the second quarter. The form and the corresponding fees are due on July 31 of the calendar year following the last day of the plan year. For plan years that ended in 2023, the deadline is July 31, 2024.
Calculating the PCORI Fee
The PCORI fee is determined by multiplying the average number of covered lives during the policy or plan year by the specified dollar amount for that year:
- For plan years ending before October 1, 2023: $3.00 per covered life.
- For plan years ending on or after October 1, 2023: $3.22 per covered life.
Defining ‘Covered Lives’
- For self-insured plans, ‘covered lives’ include both participating employees and their dependents.
- For CBIA Fixed Funding Solutions, a life count report is accessible on our website to assist with calculating your average life count.
- Only participating employees are counted as ‘covered lives’ for HRA and health FSA plans. Plan sponsors may use their monthly bills to determine this number.
Additional Resources
Contact Your Agent For More Information
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