PCORI Fee

Public agencies that provide a health reimbursement arrangement (HRA) benefit are required to pay an annual excise tax known as the Patient-Centered Outcomes Research Institute (PCORI) fee.

Requirements

• When the plan is fully insured, the carrier pays the fee.

• Plan sponsor of self-insured plans are generally responsible for paying the PCORI fee directly to the IRS (along with filing Form 720), regardless of the number of employees (and their spouses and dependents) enrolled in the health plan. Health plans subject to the PCORI fee include:

  • Group medical plans covering active and/or former employees (i.e., COBRA and retiree coverage), and their spouses and dependents

  • Grandfathered group health plans

  • Retiree-only plans

  • Health Reimbursement Arrangements (HRAs)  

When is the deadline?

• Fully insured and self-insured health plans are required to pay the PCORI fee annually by July 31 of the year following the last day of the plan year.

Calculating PCORI Fee

• The PCORI fee for plan years ending on or after October 1, 2024, and before October 1, 2025, will be $3.47 per covered life.

• PCORI fee equals the amount per enrollee (employees and dependents), based on one of the approved counting methods. Amount is based on IRS determined fee and end of plan year.

• Note, PCORI fee extended through 2029.