The Patient-Centered Outcomes Research Institute (PCORI) fee was established under the Affordable Care Act (ACA) to advance comparative clinical effectiveness research. The PCORI fee is assessed on issuers of health insurance policies and sponsors of self-insured health plans. The fees are calculated using the average number of lives covered under the policy or plan, and the applicable dollar amount for that policy or plan year. The past PCORI fees were—

  • $2 per life, for policy and plan years ending on or after October 1, 2013, and before October 1, 2014
  • $2.08 per life, for policy and plan years ending on or after October 1, 2014, and before October 1, 2015

The new adjusted PCORI fee is— 

  • $2.17 per life, for policy and plan years ending on or after October 1, 2015, and before October 1, 2016

Employers and insurers will need to file Internal Revenue Service (IRS) Form 720  and pay the updated PCORI fee by July 31, 2016

Transitional Reinsurance Fee

Like the PCORI fee, the transitional reinsurance fee was established under the ACA. It was designed to reinsure the marketplace exchanges. Contributing entities are required to make contributions towards these reinsurance payments. A “contributing entity” is defined as an insurer or third-party administrator on behalf of a self-insured group health plan. The past transitional reinsurance fees were

  • $63 per covered life for 2014
  • $44 per covered life for 2015

The new adjusted transition reinsurance fee is—

  • $27 per covered life for 2016

Although in the past, due to operational reasons, the U.S. Department of Health and Human Services would not permit contributing entities to elect to make the entire benefit year's reinsurance contribution by January 15, the operational barriers have now been fixed, and now contributing entities can elect to pay:

  1. The entire year’s contribution in one payment no later than January 15, as applicable (or, if such date is not a business day, the next applicable business day); or
  2. Two separate payments for the benefit year, with the first remittance due by January 15, as applicable (or, if such date is not a business day, the next applicable business day) reflecting the first payment of the bifurcated contribution (that is, $33.00 per covered life for 2015, and $21.60 per covered life for 2016); and the second remittance due by November 15, as applicable (or, if such date is not a business day, the next applicable business day) reflecting the second payment of the bifurcated contribution (that is, $11.00 per covered life for 2015, and $5.40 per covered life for 2016).

Payment can be made online.