Jul 23, 2024
The annual mandated fee to fund the Patient-Centered Outcomes Research Institute (PCORI) is increasing as follows:
- $3.00 per member for plan years ending on or before September 30, 2023, up from $2.79 last year.
$3.22 per member for plan years ending on or after October 1, 2023, up from $3.00 last year
It’s mandated by the Affordable Care Act and due July 31st, 2024.
PCORI fees are paid annually with the submission of IRS Form 720. Anthem pays the fee for our clients with Fully Insured funding. Self-insured clients pay the PCORI fee directly to the IRS. Small Group Anthem Balanced Funding (ABF) clients may need your guidance on calculating and paying the fees.
The IRS allows the fees to be calculated by any one of the following methods:
- The actual count method. Total lives covered each day of the year, divided by the number of days in the plan year.
- The snapshot method. Total lives covered on one date in each quarter of the plan year.
- The snapshot factor method. Lives covered on any one day may be determined by counting the actual number of lives covered on that day or by treating those with self-only coverage as one life and those with coverage other than self-only as 2.35 lives.
- The Form 5500 method. A formula that includes the number of participants reported on Form 5500 for the plan year.
We are committed to keeping you up to date regarding compliance including PCORI. Contact your Amwins Connect team to learn about the compliance tools available to you and your clients.
