Patient-Centered Outcomes Research Institute (PCORI) Fee

The Affordable Care Act (ACA) imposes a fee on health insurance issuers and plan sponsors of self-insured health plans to help fund the Patient-Centered Outcomes Research Institute (PCORI). The PCORI fee is calculated based on the average number of lives covered under a policy or plan. The plan year-end determines the applicable rate for calculating PCORI fees. Attached is the applicable rate: PCORI Filing Due Dates and Applicable Rates*

With a plan year ending before October 1, 2025: $3.47
With a plan year ending on or after October 1, 2025, and before October 1, 2026: $3.84

PCORI fees are reported and paid annually using the attached “IRS Form 720” (Quarterly Federal Excise Tax Return). These fees are generally due by July 31 of the year following the last day of the plan year. We’ve also included the “instructions” for filing Form 720.

Please note: OCI is aware and has communicated to the IRS that the applicable rates reflected on both IRS Form 720 and the filing instructions linked above have not been updated for this year.

That said, our commitment is to provide you with this information in a timely manner so you can best serve your clients. The IRS webpage listing “PCORI Filing Due Dates and Applicable Rates” and the rates listed above in this email do reflect the correct, updated rates for this year.

This year, there are THREE counting methods the employer may choose from. Please refer to the attachment “Counting Method Regulations” for full details on each of the colored options. Choosing the right counting method could lead to the employer saving some money. You may find the use of the Snapshot Factor Method to be the simplest option.

Actual Count Method
Snapshot Method
Form 5500 Method

Do not use the Snapshot Factor Method for HRA. Refer to the special counting rules in the regulations for HRA/FSA.

You may visit the IRS PCORI Website for additional information.

*Level-Funded or Self-Funded – the fee applies to all members enrolled, including employees, spouses, children, and COBRA participants.

**Fully Insured plans do not owe PCORI fees unless they have an HRA plan.

***HRA’s – the fee applies to the only employee enrolled in the HRA plan. DO NOT count spouses and children. DO count former employee COBRA participants.

Below is a table of insurance companies and plan administrator resources to assist you with calculating and filing PCORI fees.

Carrier	Location of PCORI Reports & How Employer May Obtain Them
Aetna	Employer or Agent Login on AHIA Website
Allstate/Nationwide	Employer or Agent Login on Allied Benefits Systems Website
Blue Cross and Blue Shield of Minnesota	Group Must Request from BCBSMN
Blue Cross and Blue Shield of Nebraska	OCI Pulls and Sends to Agent. Also Available on the Broker Business Portal Under “Reports” on the Dashboard
HealthPartners	Available on the Employer Portal
Medica	Group Must Request from Medica
UHC	Mailed to the Group & Website
HRAs	N/A - Please contact your HRA administrator.