The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute to study clinical effectiveness and he
alth outcomes. To finance the Institutes work, a small annual fee - commonly called the PCORI fee - is charged on group health plans.
The fee applies for each year ending between October 1, 2012 and September 30, 2019 only. The fee is an annual amount multiplied by the number of plan participants.
If your plan year ended between October 1, 2015 and September 30, 2016, then your PCORI fee for this year will be $2.17 per participant.
Insurers are responsible for calculating and paying the fee for insured plans. Employers sponsoring self-insured (self-funded) plans are responsible for calculating and paying the fee with respect to those plans.
The fee general applies to all group health plans except:
* HIPAA-excepted benefits
* Plans that do not provide significant benefits for medical care of treatment (e.g., employee
assistance, disease management and
* Stop-loss insurance policies
* Health Savings Accounts (HSA's)
A health reimbursement arrangement (HRA) that is integrated with another self-insured plan sponsored by the same employer (e.g., major medical plan or high deductible health plan) is not subject to a separate fee. If, however, the HRA stands alone, or the HRA is integrated with an insured plan, or the HRA is integrated with a different sponsor's self-insured plan, then the HRA plan sponsor must calculate and pay the fee.
Payment is due by July 31 following the calendar year in which the plan year ends. Use IRS Form 720, Quarter Federal Excise Tax Return.
Rawls Insurance Group will provide calculations for our groups that are self-funded. If you are unsure about your plan, please give us a call. 844-551-9833.
For FAQ's on PCORI Fee's click