Answer from Angela, CIC, CISR, SHRM-CP :
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 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.
This Q&A does not constitute legal advice and does not address state or local law.
Angela began her insurance career in 1997 and maintains professional designations as a Certified Insurance Counselor (CIC), Certified Insurance Service Representative (CISR) and SHRM Certified Professional (SHRM-CP). She has spent the last decade focusing on supporting employers and the benefits broker community on benefits compliance strategies. Angela is a national speaker in her field and a faculty member of The National Alliance for Insurance Education and Research.
