GBS ACA Compliance
Self & Level Funded Plan Sponsors Must Submit PCORI Fee By July 31 Each Year
Fee Effective Through 2029
Quick Summary
What
The Patient-Centered Outcomes Research Institute (PCORI) fee was created by the Affordable Care Act (ACA) and was effective beginning 2012.
Who
Employers that sponsor self/level funded plans must submit the fee. Employers that sponsor insured plans need not submit because their carriers will submit instead.
When
The fee is submitted and paid once a year by no later than July 31 of the following year
- For example, all plans that ended in 2024 pay the 2024 fee by July 31, 2025
Amount
The fee is calculated by multiplying the per person fee amount by the plan’s average number of covered lives. A plan MUST calculate average number of lives using one of the following:
- Actual count method
- Snapshot count method or snapshot factor method
- Form 5500 method
The per person fee amount is adjusted each year and takes effect each October. Consequently, the amount an employer pays per covered life depends on when the plan year ends. For example, the fee due July 31, 2025 has two different fee amounts:
- Plans that ended January 2024 through September 2024 pay $3.22 per covered life.
- Plans that ended October 2024 through December 2024 pay $3.47 per covered life.
How
The fee is submitted using IRS Form 720, see the IRS PCORI Fee webpage.
Updated December 2024
This document provides an overview of a specific regulatory development. It is not intended to be, and should not be construed as, legal advice for any particular situation.
