PCORI Fees Due for Self-Funded Insurance Plans – July 17, 2014 by Angel Rice

A reminder for business owners: if you have self-funded accident and health insurance or major medical insurance coverage and the plan year ended between January 1, 2013, and September 30, 2013, your PCORI fee of $1 per member is due July 31, 2014 — and cannot be extended.

A member is defined as all covered lives — employees, their spouses and their dependents. This is different than the definition used for Form 5500 participant count, which only counts employees.

There are four different methods that can be used to calculate the number of covered lives; the one that is the most beneficial to your situation can be used.

  1. Actual count. Count the total number of covered lives for each day of the plan year; add them together and divide by the number of days in the plan year.
  2. Snapshot dates. Count the total number of covered lives on a single day on each quarter; add those together and divide by the number of dates on which a count was made.
  3. Snapshot factor (used if there is both “self-only coverage” and “other than self-only coverage”). Determine the sum of the number of participants with self-only coverage plus the number of participants with other than self-only coverage and multiply by 2.35.
  4. Form 5500 method (used only if Form 5500 will be filed prior to the deadline for the PCORI fee). For self-only coverage, combine the total participants at the beginning of the plan year with the total number of participants at the end of the year as reported on Form 5500; divide by two. For self only and other than self only, sum the total number of participants covered at the beginning and end of the year as reported on Form 5500.

Read our previous post for more background on PCORI fees.

We want to hear from you! We encourage you to share this blog post on social media or contact Angel Rice at arice@cohencpa.com or a member of your service team for further discussion.


This communication is for information only, and any action should only be taken after a detailed review of the specific situation and appropriate consultation.