Question:

What is PCORI filing?

Answered by the HR Experts

The Affordable Care Act (ACA) created the Patient-Centered Outcomes Research Institute (PCORI) to study clinical effectiveness and health outcomes. To finance the institute’s work, a small annual fee—commonly called the PCORI fee—is charged on group health plans.

PCORI filing is completed by insurers for fully insured plans and by plan sponsors of self-funded plans. PCORI filing is generally not required for standalone, self-funded dental or vision plans if they are considered “excepted benefits.” A plan qualifies as excepted benefits if it is not an integral part of the group health plan, meaning participants are able to decline or opt out of the coverage, and claims and benefits are administered under a separate contract from the group health plan.

Employers sponsoring self-funded and level-funded plans—such as group medical coverage, COBRA continuation, and most health reimbursement arrangements—must calculate their PCORI fee using one of the three allowable methods and file by July 31.

You can learn more about PCORI filing on the platform.

This Q&A does not constitute legal advice and does not address state or local law.