PCORI Fee Calculator

PCORI Fee Formula:

\[ \text{PCORI Fee} = \text{Average Number of Covered Lives} \times 3.47 \]

PCORI Fee:

1. What is the PCORI Fee?

The PCORI (Patient-Centered Outcomes Research Institute) fee is an annual fee required by the Affordable Care Act to help fund medical research. It applies to health insurance policies and self-insured health plans for plan years ending between October 1, 2024 and September 30, 2025.

2. How Does the Calculator Work?

The calculator uses the PCORI fee formula:

\[ \text{PCORI Fee} = \text{Average Number of Covered Lives} \times 3.47 \]

Where:

Average Number of Covered Lives — Can be calculated using actual count, snapshot, or Form 5500 method
3.47 — The current PCORI fee rate (in USD) for applicable plan years

3. Importance of PCORI Fee Calculation

Details: Accurate PCORI fee calculation is required by law for applicable health plans. The fee helps fund important patient-centered outcomes research that informs better healthcare decisions.

4. Using the Calculator

Tips: Enter the average number of covered lives for your plan year. The calculator will automatically apply the current rate of $3.47 per covered life.

5. Frequently Asked Questions (FAQ)

Q1: Who must pay the PCORI fee?
A: Sponsors of self-insured health plans and issuers of specified health insurance policies.

Q2: When is the PCORI fee due?
A: The fee is due by July 31 of the year following the last day of the plan year.

Q3: How is the average number of covered lives determined?
A: There are three methods: actual count method, snapshot method, and Form 5500 method.

Q4: Does the PCORI fee apply to all health plans?
A: No, there are exemptions including certain HRAs, FSAs, and plans that provide primarily excepted benefits.

Q5: How often does the PCORI fee rate change?
A: The rate is adjusted annually for inflation and applies to plan years ending in that calendar year.