The Patient-Centered Outcomes Research Institute (PCORI) fee supports the Patient-Centered Outcomes Research Trust Fund, which will conduct comparative effectiveness research. The fees will be imposed for each policy year ending on or after October 1, 2012 and before October 1, 2019.
Fully insured and self-insured plans providing accident or health insurance for individuals living in the U.S. are subject to the fee. Plans established and maintained by an employer or employee organization to provide accident and health coverage are subject to the fee. This includes retiree-only plans, but does allow certain exemptions, such as excepted benefits.
Note: the insurer is responsible for paying the PCORI fee for fully insured plans.
Amount of Fee
The amount of the PCORI fee is equal to the average number of lives covered during the policy year or plan year multiplied by the applicable dollar amount for the year.
- For policy and plan years ending after December 31, 2013, and before Oct.1, 2014, the applicable dollar amount is $2.00.
- For policy and plan years ending after Sept. 30, 2014, and before Oct. 1, 2015, the applicable dollar amount is $2.08.
- For policy and plan years ending after Sept. 30, 2015, and before Oct. 1, 2019, the applicable dollar amount is further adjusted to reflect inflation in National Health Expenditures, as determined by the Secretary of Health and Human Services.
Calculating Average Number of Covered Lives
The fee is to be based on the average number of lives in the plan, which can be calculated in one of several ways:
Certain counting rules exist for FSAs and HRAs:
The fees must be reported once a year on IRS Form 720 (Rev. April 2014) (Instructions). This form must be filed and fees paid on July 31 of the calendar year immediately following the last day of the plan year.