PCORI Fee Increase for Plan Years Beginning on or After October 1, 2021

The applicable dollar amount to determine PCORI fees will increase from $2.66 to $2.79 for plan years ending after September 30, 2021 and before October 1, 2022 according to Notice 2022-4 issued by the Internal Revenue Service (IRS) on December 21, 2021.

Health insurance issuers and self-funded health plans are required to pay PCORI fees for Plan Years ending on or after October 1, 2012 and on or before September 30, 2029.  The fee had originally expired on October 1, 2019 but was extended 10 years by the Further Consolidated Appropriations Act of 2020.  These fees help fund the Patient-Centered Outcomes Research Institute (PCORI).

The fee amount is calculated by multiplying the average number of covered lives during the Plan Year by the applicable dollar amount for that Plan Year.  Fees for fully insured plans are included in their premium payments.  Fees for self-funded plans are reported and paid annually using the IRS Form 720 which is due on July 31st of each year.

The table below provides a history of the applicable dollar amount for each Plan Year:

Plan Years Ending Between Applicable Dollar Amount
October 1, 2012 and September 30, 2013 $1.00
October 1, 2013 and September 30, 2014 $2.00
October 1, 2014 and September 30, 2015 $2.08
October 1, 2015 and September 30, 2016 $2.17
October 1, 2016 and September 30, 2017 $2.26
October 1, 2017 and September 30, 2018 $2.39
October 1, 2018 and September 30, 2019 $2.45
October 1, 2019 and September 30, 2020 $2.54
October 1, 2020 and September 30, 2021 $2.66
October 1, 2021 and September 30, 2022 $2.79

PCORI Fee Announced for Year 3 of Program

The Internal Revenue Service (IRS) issued Notice 2014-56 announcing the PCORI fees applicable to health plans for plan and policy years ending on or after October 1, 2014 and before October 1, 2015 is $2.08. These fees are calculated using an average number of covered lives and an annually announced applicable dollar amount. The applicable dollar amount for plan and policy years ending on or after October 1, 2012 and before October 1, 2013 was $1.00. This dollar amount was increased to $2.00 for plan and policy years ending on or after October 1, 2013 and before October 1, 2014.

For policy years and plan years ending October 1, 2015, through September 30, 2019, the adjusted applicable dollar amount will be published in future guidance in the Internal Revenue Bulletin.