FAQs About the Patient Centered Outcomes Research Institute (PCORI) Fee

The PCORI fee applies to all plans that provide medical coverage to employees. Medical coverage includes Preferred Provider (PPO) Plans, Health Maintenance Organization (HMO) Plans, Point-of-service (POS) Plans, High-Deductible Health Plans (HDHPS), and Health Reimbursement Arrangements (HRAS).

What is the Patient-Centered Outcomes Research Trust Fund fee?

The Patient-Centered Outcomes Research Trust Fund fee is a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans that helps to fund the Patient-Centered Outcomes Research Institute (PCORI). The institute will help patients, clinicians, purchasers and policymakers make better-informed healthcare choices by advancing clinical effectiveness research.

When is the PCORI fee due?

The fee is due by July 31 of the year following the last day of the plan year. The fee initially applied from 2012 to 2019, based on plan/policy years ending on or after October 1, 2012, and before October 1, 2019. However, in December 2019, the Further Consolidated Appropriations Act, 2020 extended the fee to plan/policy years ending before October 1, 2029.

View the below FAQs about the PCORI fee:

• What plans does the PCORI fee apply to?
• Does the fee apply to all medical plans?
• Who must pay the fee?
• When is the PCORI fee due?
• How much is the fee?
• What if the plan terminates?
• What if a plan is new?
• How is the fee calculated?
• May an employer change its calculation method?
• What if the employer sponsors multiple plans?
• How is the fee paid?
• Is the fee tax-deductible?
• Is there a penalty for failure to file or pay the PCORI fee?
• How does a plan sponsor correct a previously filed Form 720?
• Do groups need to file and pay PCORI fees if they offer an FSA?
• Do groups have to file twice if group benefits run on calendar year, but the renewal and FSA run on different months?

For help understanding and strategically managing your benefit's plan, contact an SSG Advisor.