PCORI Reports - Posted Online
Dear Clients:

The annual PCORI reports have been completed and loaded online for your convenience at kba.e-zbenefits.com They are located within the documents section of the portal. This report notes the average number of lives covered by your group health plan using the actual count method in order to aid in your completion of Form 720.

Please review the below instructions on how to access your PCORI report and view the helpful tips for completing Form 720.

If you have any questions, please reach out to your KBA client representative.

Sincerely,
Nicole R. Oliver, Senior Vice President
Client Relations
Key Benefit Administrators
KBA PCORI Report that lists the Average Covered Lives covered by your group health plan have been uploaded online at:  

(PCORI Reports will be listed under forms & documents)  

The fee for policy and plan year ending after October 1, 2021, and before October 1, 2022 the applicable rate of $2.79 is multiplied by the average number of lives covered under the policy or plan to determine the amount to submit using Form 720.

The fee for policy and plan year ending after October 1, 2022, and before October 1, 2023 the applicable rate of $3.00 is multiplied by the average number of lives covered under the policy or plan to determine the amount to submit using Form 720.

See Patient-centered outcomes research trust fund fee Questions and Answers for more information.
Deadline to file and submit Form 720 is
July 31, 2023
FORM 720 - Quarterly Federal Excise Tax Form (Rev. June 2022)
HOW TO COMPLETE
Helpful Tips:
  • Complete top section (Name of Company, Address, Employer Identification Number (EIN), Quarter Ending (Note: Second Quarter/2nd Quarter)

  • Go to Part II Section 133 - Under Applicable Self-Insured Plans Complete:
  • Column A - Average Number of Lives
  • Column B - Rate for Average Covered Lives (already populated)
  • Column C - Note Fee
(Refer to KBA PCORI Report for information)

  • Go to Part III Section - Add total - Line 10 include total only if there are no other fees outside of PCORI being filed.

  • Sign Form & Complete Payment Voucher (Include amount of payment)

  • Submit payment online or send by mail delivery to:

Department of Treasury
Internal Revenue Service
Ogden, UT 84201-0009