Self-insured plans assessed PCORI fee under health reform?


Your company has a self-insured health plan that runs on a calendar-year basis. Does your plan have to pay the PCORI fee established under health reform and, if so, how much is it and when is it due?


The Patient Protection and Affordable Care Act (PPACA) created the Patient-Centered Outcomes Research Institute (PCORI), which assists patients, clinicians, purchasers, and policymakers in making informed health decisions. To help fund the PCORI, PPACA imposes a fee on self-insured health plans. The fee applies for policy or plan years ending on or after October 1, 2012, and before October 1, 2019.

The fee applicable to the 2012 plan year is $1.00 per covered life, which must be reported and paid by July 31, 2013, for calendar-year plans. The $1.00 per covered life fee increases to $2.00 for plan years ending on or after October 1, 2013, and before October 1, 2014. The $2.00 fee increases in future years based on certain health expenditure data. Employers who sponsor self-insured health plans should file IRS Form 720.

For self-funded plans, the plan sponsor is responsible for paying the PCORI fee. According to IRS final regulations, the plan sponsor is generally the employer that established or maintains the plan. However, the regulations provide other rules for other types of plans; the board of trustees is the plan sponsor of a multiemployer plan, and the committee is the plan sponsor of a MEWA.

Source: 77 FR 235, December 6, 2012.

[ Return to top of document ]