PCORI Fees for Self-Insured Plans

Employers that sponsor certain self-insured health plans are responsible for fees under Health Care Reform to fund the Patient-Centered Outcomes Research Institute (PCORI). The fees support research to evaluate and compare health outcomes and the clinical effectiveness of certain medical treatments, services, procedures, and drugs.

Affected Self-Insured Plans
PCORI fees are imposed on plan sponsors of applicable self-insured health plans for each plan year ending on or after October 1, 2012, and before October 1, 2019. Applicable self-insured health plans generally include any plan for providing accident or health coverage if any portion of the coverage is provided other than through an insurance policy, including health reimbursement arrangements (HRAs) and health flexible spending arrangements (FSAs) that are not treated as excepted benefits. (Note: According to agency guidance, a health FSA that does not qualify as excepted benefits is not integrated with a group health plan, and thus, it will fail to satisfy certain ACA market reforms.) 


CLICK HERE to see how PCORI fees may apply to specific types of health coverage or arrangements.

Calculating the Fee
For plan years ending on or after October 1, 2015 and before October 1, 2016, the fee is $2.17 (multiplied by the average number of lives covered under the plan).


For plan years ending on or after October 1, 2016 and before October 1, 2019, the fee will be further adjusted to reflect inflation in National Health Expenditures.


Details on how to determine the average number of lives covered under a plan, as well as various examples, are included in the final regulations.


How to Report and Pay the Fee
Plan sponsors of applicable self-insured health plans are required to report and pay the fee for a plan year no later than July 31st of the calendar year immediately following the last day of the plan year to which a fee applies. The final regulations do not permit or include rules for third-party reporting or payment of the PCORI fee. Fees are reported and paid using IRS Form 720, Quarterly Federal Excise Tax Return. Click here for Instructions.  


The information provided is for educational purposes only. This information is from sources we believe to be reliable, but we cannot guarantee or represent that it is accurate or complete. The opinions are those of the writer, and the opinions and information presented are subject to change without notice.

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