The Patient-Centered Outcomes Research Institute (PCORI) is a federally authorized nonprofit organization that funds research to help patients, caregivers, and clinicians make more informed healthcare decisions. Established under the Affordable Care Act in 2010 and extended through 2029, PCORI’s work is supported by an annual fee collected from certain health insurance plans.
This fee, known as the PCORI Fee, applies to self-insured health plans and is reported to the IRS using the Form 720 Quarterly Tax Return Form. It is filed only once a year and due by July 31.
Does My Company Need to Pay the PCORI Fee?
If your company offered a self-insured health plan during the previous calendar year, you are required to pay the PCORI fee. Individual Coverage Health Reimbursement Arrangements (ICHRA) are considered a self-funded plan.
PCORI fees are due by July 31 of the year following your plan year. For example, if 2024 is your first year offering an ICHRA, you will not owe the PCORI fee until July 31, 2025—for the 2024 plan year.
How Is the PCORI Fee Calculated?
The PCORI fee is based on the average number of lives covered under your plan for the applicable year. For filings due July 31, 2025, the fee is $3.47 per covered individual for plans ending between October 1, 2024, and September 30, 2025.
Employers may use one of the following methods to determine this average number of lives on their plan:
Actual Count Method
Count the total number of individuals (employees + covered spouses + dependents) covered each day of the plan year and divide by the number of days.
Snapshot Method
Count the total number of individuals (employees + dependents) on certain dates and average them.
For employers offering an ICHRA, this means the $3.47 applies to each employee who accepted your ICHRA contribution and their dependents. Employees who declined coverage are not included in the count.
COBRA participants count as "covered individuals."
How Do I File and Pay the PCORI Fee?
You have two options:
1) Venteur can assist you. Watch out for specific guidance via your Venteur Employer Portal
2) Or, if you prefer to handle this independently, please follow the Instructions for Form 720.
Questions?
We’re here to support you. If you have questions about the PCORI fee or need help navigating the process, please contact us at support@venteur.com.