If you sponsor a self funded or level funded health plan for your employees, there is a federal fee you are required to pay every year by July 31.
Below is a look at what the fee is, who is responsible for paying it, and how to make sure your team stays on top of it.
What Is the PCORI Fee?
PCORI stands for the Patient-Centered Outcomes Research Institute.
The Affordable Care Act imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Trust Fund, which is the funding source for the institute.
The fee is based on the average number of lives covered under the policy during the plan year.
Recent legislation keeps this fee in place for plan years ending before October 1, 2029. Beyond that, Congress hasn’t made official plans.
The fee is paid using IRS Form 720 and carries real penalties if missed or filed late.
Updated PCORI Rates for 2025 and 2026
The IRS updated the per-covered-life rates with Notice 2025-61. Here is how the rates break down by plan year.
Plan Years Ending January 1, 2025 – September 30, 2025
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Fee: $3.47 per covered life
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Filing deadline: July 31, 2026
Plan Years Ending October 1, 2025 – December 31, 2025
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Fee: $3.84 per covered life
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Filing deadline: July 31, 2026
Plan Years Ending January 1, 2026 – September 30, 2026
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Fee: $3.84 per covered life
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Filing deadline: July 31, 2027
The fee is calculated based on the average number of covered lives during the plan year, including employees, spouses, and dependents enrolled in the medical plan.
Who Is Responsible for Filing?
This is where employers sometimes get tripped up.
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If you are fully insured, your carrier handles this and you do not need to file.
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If you are self-funded, level-funded, or have a standalone HRA, the responsibility falls directly on you as the plan sponsor to file with the IRS by the July 31 deadline.
Missing the deadline can result in penalties and interest from the IRS.
Why This Is Worth Putting on Your Calendar Now
A few hundred dollars in PCORI fees is rarely a budget concern. What matters is the discipline around it.
For employers on self-funded or level-funded plans, PCORI is one of several compliance requirements that come with that structure.
Staying on top of these details is part of what makes self-funding work well long-term.
It also helps to build PCORI fees into your annual benefits budget.
The rates have been adjusting incrementally over the years, and that trend is expected to continue through 2029.
A Simple Action Plan
Three things to do before July 31:
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Confirm your plan type — self-funded, level-funded, or fully insured
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Count your average covered lives for the applicable plan year
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Calendar the deadline and assign responsibility to the right person on your team
If you work with a benefits advisor, loop them in. A good advisor should already have this on their radar for you.
At JDI Group, we work alongside South Florida employers to stay ahead of compliance requirements like this.
If you have questions about your plan structure or want a second set of eyes on your benefits strategy, we are happy to connect.
Send us a DM and we will get back to you.
