PCORI Fee for Self-Funded Health Plans
The PCORI fee is an annual excise fee. Insurers pay for specified insured policies; plan sponsors pay for applicable self-insured health plans, including certain HRAs.
Reviewed July 29, 2026 · Source-led practitioner reference
2026 filing
The fee is reported and paid once a year on second-quarter Form 720 by July 31 of the calendar year following the end of the applicable plan year. For plan years ending on or after October 1, 2025, and before October 1, 2026, the rate is $3.84 multiplied by the average number of covered lives. Earlier ending dates can use a different rate.
Counting methods for self-funded plans
| Method | Core approach |
|---|---|
| Actual count | Total covered lives for each day divided by days in the plan year |
| Snapshot | Covered lives on consistent dates in each quarter using a permitted snapshot method |
| Form 5500 | Uses participant counts under the conditions and timing in the instructions |
Coverage questions
- Is the medical plan insured or self-funded?
- Does the sponsor maintain an HRA alongside insured coverage?
- Can multiple self-funded arrangements be treated as one plan for counting?
- Does an exception apply to the arrangement?
Control checklist
- Inventory every health arrangement and identify the responsible payer.
- Match the plan-year end to the correct published rate.
- Select and document a permitted counting method.
- Reconcile lives to enrollment and Form 5500 data.
- File Q2 Form 720, pay by July 31, and retain the calculation and return.
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Use this public guide for quick orientation and source review. Inside PrepToPay Benefits, you can study the topic in structured lessons, practice applying it, review flashcards, and track your progress.
Primary sources
Educational reference only. Plan documents, governing law, agency guidance, and plan-specific professional advice control.
Keep building your Benefits control system.
Next, verify that every covered dependent satisfies the plan’s written eligibility terms.