The article tracks the applicable PCORI fee amounts that self-funded employers are required to pay by plan year and the timing for those payments. The fee is used to fund comparative effectiveness research. All health plans that provide Minimum Essential Coverage are subject to the PCORI tax/fee including plans that do not provide Minimum Value.
- Fully insured plans – paid by health insurer
- Self-funded plans – paid by employer
Employers pay the fee by July 31 in the calendar year after the end of the applicable plan year using Form 720 (Part II: Applicable self-insured health plans). Employers use one of two counting methods (Actual Count or Snapshot Dates) to determine the average number of lives covered. Most plan administrators provide simplified reporting to assist employers in computing their payment amount. Employers should contact their plan administrator.
- Actual Count Method – Add total number of members covered for each day of the plan year and divide by the number of days in the plan year.
- Snapshot Dates – Add total number of members covered on a date or dates during each quarter of the plan year and divide by the number of dates used. The dates used in each quarter must be within three days of the date used in the first quarter.
The table below represents the official fee amounts for published years as well as our own estimates reflecting future inflation under the IRS’s mathematical framework. The applicable fee amount is determined by when the last day of the plan year occurs. The table assumes that the employer uses a standard 12 month plan year (to make it easier to understand) and remember a plan year ends on the day before the next plan year starts. E.g.: A 12-month plan year that begins on Oct 1 ends on Sep 30 the following year.
| Plan Years Ending | Plan Years Starting (assumes 12 mo plan yr) |
Due Date | Fee Amount PMPY | Actual or Projected? |
|---|---|---|---|---|
| Oct–Dec 2012 | Oct 2, 2011 – Jan 1, 2012 | Jul 31, 2013 | $1.00 | Actual |
| Jan–Sep 2013 | Jan 2, 2012 – Oct 1, 2012 | Jul 31, 2014 | $1.00 | Actual |
| Oct–Dec 2013 | Oct 2, 2012 – Jan 1, 2013 | Jul 31, 2014 | $2.00 | Actual |
| Jan–Sep 2014 | Jan 2, 2013 – Oct 1, 2013 | Jul 31, 2015 | $2.00 | Actual |
| Oct–Dec 2014 | Oct 2, 2013 – Jan 1, 2014 | Jul 31, 2015 | $2.08 | Actual |
| Jan–Sep 2015 | Jan 2, 2014 – Oct 1, 2014 | Jul 31, 2016 | $2.08 | Actual |
| Oct–Dec 2015 | Oct 2, 2014 – Jan 1, 2015 | Jul 31, 2016 | $2.17 | Actual |
| Jan–Sep 2016 | Jan 2, 2015 – Oct 1, 2015 | Jul 31, 2017 | $2.17 | Actual |
| Oct–Dec 2016 | Oct 2, 2015 – Jan 1, 2016 | Jul 31, 2017 | $2.26 | Actual |
| Jan–Sep 2017 | Jan 2, 2016 – Oct 1, 2016 | Jul 31, 2018 | $2.26 | Actual |
| Oct–Dec 2017 | Oct 2, 2016 – Jan 1, 2017 | Jul 31, 2018 | $2.39 | Actual |
| Jan–Sep 2018 | Jan 2, 2017 – Oct 1, 2017 | Jul 31, 2019 | $2.39 | Actual |
| Oct–Dec 2018 | Oct 2, 2017 – Jan 1, 2018 | Jul 31, 2019 | $2.49 | Projected |
| Jan–Sep 2019 | Jan 2, 2018 – Oct 1, 2018 | Jul 31, 2020 | $2.49 | Projected |
Links to Resources:
- IRS Notice 2014-56 – shows the inflation to $2.08
- IRS Notice 2015-60 – shows the inflation to $2.17
- IRS Notice 2016-64 – shows the inflation to $2.26
- IRS Notice 2017-61 – shows the inflation to $2.39
- IRS Resource Page
- IRS Q&A Page
- Form 720 and Instructions
- National Health Expenditures Resource Page (updated annually; last updated 2/16/2018)
- Table showing the calculation of our projections