Updated on 5/17/24
The Deadline to Pay PCORI Fees is Monday, July 31, 2024.
The Patient-Centered Outcomes Research Institute (PCORI) is an independent, non-profit organization established by the United States Congress. Its primary goal is to conduct research that informs healthcare decisions and helps patients, caregivers, and healthcare providers make more informed choices. PCORI funds research projects and initiatives focused on patient-centered outcomes.
To support its activities, PCORI imposes fees on certain health insurance plans.
PCORI fees were established as part of the Patient Protection and Affordable Care Act (ACA) passed in 2010. These fees are intended to provide a sustainable funding source for PCORI’s research endeavors. The PCORI fees apply to both fully insured health plans and self-insured health plans.
How Do I Know What the PCORI Fee Will Be?
The calculation of PCORI fees differs depending on the type of health plan. Here’s a breakdown of the two categories:
- Fully Insured Health Plans: Insurance companies are responsible for calculating and paying the PCORI fees for fully insured health plans. Typically, the PCORI fees are included in the premium amount paid by employers. Employers need not file any additional paperwork or make direct payments for PCORI fees.
- Fully Insured Health Plans with an HRA: The insurance company will pay the fee for the insured plan. However, the employer must pay the fee for the number of employees enrolled in the HRA.
- Self-Insured Health Plans: The responsibility for calculating and paying PCORI fees falls upon the plan sponsor or employer for self-insured health plans. The fees are reported and paid using Form 720, which is filed quarterly with the Internal Revenue Service (IRS).
The PCORI fee rates are adjusted annually and are determined based on the plan year-end date. The fees are assessed on a per-covered individual basis, including employees, dependents, and retirees. As a reminder for employers, the rate for covered individuals with plans that end on or after October 1, 2021, and before October 1, 2023, is $3.00. For plans that end on or after October 1, 2024, and before October 1, 2023, the PCORI rate per covered individual is $3.22.
How BlueStone Services Can Help
Employers and plan sponsors must ensure compliance with PCORI fee requirements to avoid penalties or fines.
If you need help navigating these fees, contact us to get started with an HR consultant today!
