Background

The ACA includes a number of fees that insurers and employers are required to pay in order to help support various aspects of healthcare reform. One of those fees, the Patient-Centered Outcomes Research Institute or PCORI fee, is a relatively minor fee, but is structured in a way as to cause some confusion about who it applies to, and when it is to be paid.

The PCORI fee is paid via IRS Form 720, the Quarterly Federal Excise Tax Return. Because Form 720 is filed on a quarterly basis, the timing for actually paying the fees is somewhat confusing. The bottom line for self-funded plans is that payment is due by July 31 of the year following the last day of the policy or plan year. The instructions for Form 720 and the form itself can be found here.

PCORI Fee Adjusted

The IRS released the adjusted PCORI (Patient-Centered Outcomes Research Institute) rates for plan years ending on or after October 1, 2016 and before October 1, 2017.

The below chart will be able to assist employers in understanding what their applicable fee is based on plan year, based on the fees that have currently been released.

PCORI fees are paid by the carriers for fully insured plans, whereas it is the responsibility of self-funded plans to file and pay the PCORI fee themselves utilizing Form 720.

For more information, please contact your Assurance representative.

Information contained herein is not intended to constitute tax or legal advice and should not be used for purposes of evading or avoiding otherwise applicable regulatory responsibilities as issued by the federal or state government(s) and/or taxes owed under the Internal Revenue Code. You are encouraged to seek advice from your legal or tax advisor based on your circumstances.