3 Steps Employers Need to Take to Set Up Their ICHRA Reimbursement Procedure

If you’re ready to officially move forward with the setup and launch of your company ICHRA, you’ll want to be sure you’re streamlining every step of your process. It’s also recommended that you pay special attention to how you set up and introduce your reimbursement procedures. Participating employees won’t opt-in and run the risk of becoming ineligible if they don’t inherently understand how to leverage the ICHRA plan benefits or are confused about how an ICHRA might benefit them directly. Today, we’ll outline those critical setup steps businesses should be taking when establishing a first-time reimbursement model.

1. Transparency in Employee Eligibility Guidelines

Your company ICHRA should be entirely transparent with regard to eligibility guidelines. Since an ICHRA is much different from the traditional group plan that your teams might be used to having, clear rules and next steps should be communicated throughout the introduction and reimbursement process. This is new to them. Make sure they understand how the ICHRA works and offer reminders for everyone opting-in for the first time. Here are a few key details that will likely require definitions and eligibility explanations for your staff.

Ensure Employees Know How to Qualify

An ICHRA can be leveraged by your full and part-time employees, as you see fit. But others are also eligible who may not normally be accustomed to having reimbursement benefits as part of your ICHRA model. Any seasonal workers, temporary workers, or contracted staff you plan to include will also need to be briefed on their newly available reimbursement steps.

Ensure Employees Understand Timelines for Eligibility

For everyone participating in your ICHRA, there will be a timeline of eligibility. In order to qualify for reimbursements, employees will need to provide proof of health insurance enrollment elsewhere, either through the ACA Marketplace or a private provider enrollment. Typically, there are 60 days from the start date of an ICHRA offering for employees to finalize their health insurance enrollment decisions. This also applies to new hires or special enrollment periods with start dates. Missing these timelines means missing out on critical reimbursements. It can also be helpful to explain to your participating employees how to get started when browsing for a new ACA health plan, including FREE resources like W3LL.

Ensure Employees Know Your ICHRA Start Date

As your company rolls out the plans for launching your ICHRA, make sure you communicate specific start dates for all to know. This will be the official date that kicks off that aforementioned 60-day timeline for employees to enroll in health insurance plans. Remember, without proof of insurance, within the dedicated timeline, employees will not be eligible to participate in your ICHRA.

2. Understanding Qualifying Reimbursements

Setting up your company ICHRA also means outlining clear definitions for what constitutes a reimbursable expense. Here’s where you’ll decide what can and can’t be submitted for reimbursement. And explaining these definitions to your participating teams needs to be clear and consistent.

Clear Definitions for Premium Reimbursements

Some ICHRA plans can be designed to offer reimbursements for monthly insurance premiums. Usually, these include marketplace plan premiums. But they can also apply to any employees you have on-staff currently enrolled in Medicare or Medicare Plus plans. Whatever premium reimbursements you plan to offer, make sure you communicate guidelines for your employees about them.

Clear Definitions for Medical Expense Reimbursements

Because ICHRAs operate differently from traditional group plans, you might need to explain what medical expenses qualify for reimbursements. For example, in-network versus out-of-network provider requirements no longer apply in an ICHRA environment. And any health-related service can be eligible, based on what your company chooses, including dental, vision, chiropractic, mental health services, and even substance abuse treatment services.

Clear Definitions for Prescription Expense Reimbursements

Prescription definitions may matter, too. Under some health insurance plans, which will have been chosen individually at the employee level, there may be mandates regarding generic brands versus primary brands of prescription medicines. You’ll want to communicate how your ICHRA reimburses, regardless of the brand and more in line with direct out-of-pocket prescription costs.

3. Introducing Employees to Your ICHRA Process

Obviously, you’ll want to outline a path for your employees to follow when it comes time to submit their requests for reimbursements. Your company will want to document and manage those flows of requests and reimbursements, as well. Here are a few critical points to include in your process explanations.

How They Submit

Avoid haphazard methods for reimbursements, like allowing teams to just drop physical receipts in your HR Manager’s office. Instead, develop a dedicated channel for uploading, tracking, and archiving submitted receipts, along with paid reimbursements. A digital dashboard is often the best way to track and manage these flows of requests and payments.

When They Can Expect Reimbursements

Be clear about when employees should expect to see approvals and reimbursements. Consider implementing an appeal process, as well, should you deny an expense that a team member feels should qualify. Some companies reimburse staff immediately upon approval, while others roll in these reimbursements with regular expense reporting processes.

What Their Reimbursement Limits

As you set up your company’s ICHRA reimbursement procedures, it’s best to be precise with your employees about any reimbursement limits you set. These are usually derived based on company budget allowances. And you’ll want to determine those amounts prior to launching your ICHRA. Employees will need to understand what their personal limits are so they can make the best decisions for themselves about incurring and submitting expenses.

As you explore your ICHRA plans, don’t forget that W3LL can help. We can assist with developing a reimbursement procedure that works best for your business model and employees. And we can also serve as a third-party administrator, should you want to set up the internal dashboard for seamless ICHRA tracking and managing of reimbursements. We’ll help you keep an eye on internal opt-in trends, timelines, and budget monitoring year-round.