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The Individual Coverage Health Reimbursement Arrangement (ICHRA) quickly gained traction among thousands of U.S.-based companies in 2021. It’s much different from the traditional group health insurance coverage that workers might be used to having.

Your employer is rolling out an ICHRA. Now, what do you do?

If you’re facing an ICHRA transition at your workplace, these are the three steps to take first. And we’ll almost bank on you preferring this new way to experience employer-sponsored healthcare benefits.

1. Understanding Your ICHRA

Because an ICHRA is entirely owned, managed, and set up by the employer, you’ll want to dive in to find out just what parameters are involved with yours specifically. Before you jump to any other decisions, including choosing health coverage, familiarize yourself with how your company’s ICHRA will work, starting with these basics.

Know What’s Reimbursable and What’s Not

Some ICHRAs provide reimbursements for more than just out-of-pocket medical expenses you incur in a year. Some have provisions to reimburse monthly premiums you might pay for an ACA Marketplace insurance plan. Others offer reimbursements for extras, too, including dental receipts and vision care receipts. Before you decide on your health insurance plan, start by creating a list and having an understanding of what your company’s ICHRA will reimburse.

Know Your Timelines to Opt-In

Timing matters when it comes to participating in an employer-sponsored ICHRA. Make sure you understand what timelines are applicable in your situation. Typically, employees have 30 days to enroll in a qualified health insurance plan before they can participate in the ICHRA. And there may be other considerations if you’re a new hire or experiencing a Qualifying Life Event (QLE.) Don’t waste time deliberating and inadvertently miss out on participation altogether.

Know Who to Go to with Questions

Every ICHRA should have a designated department or contact responsible for fielding questions and processing reimbursement requests. Your company might have a third-party administrator, like W3LL, with an online dashboard you can use to manage your requests. Other companies may manage their ICHRAs entirely within an HR department or ICHRA-dedicated team. Just know who your contact is or where you can turn to for help with questions throughout the year.

2. Choosing Health Insurance Plans

Once you really know the lay of the land with regard to your company’s ICHRA, it’s time to move forward with browsing and enrolling in a health insurance plan. Since this decision should be based on your healthcare needs, preferences, and budgets, your health coverage shopping process should be thorough. Here are a few reminders.

Open & Special Enrollment

Know if you’re able to browse the ACA Marketplace to enroll as part of an open enrollment period or special enrollment period. Typically, open enrollment occurs at the end of the year. But your employer may be authorized to leverage a special enrollment period due to the change in plans qualifying as a life-changing event for staff. In either scenario, you’ll have an allotted amount of time to make your final enrollment decisions.

Choosing & Enrolling in a Plan Right for You

You can begin browsing available health insurance plans by visiting healthcare.gov. And you’ll be able to sort through plans based on pricing and coverage. But be sure to explore any premium tax credits you might be eligible to receive to greatly reduce the monthly premium burdens. Once your tax credits are calculated, you can view plans to compare costs, copays, in-network versus out-of-network, and deductibles. If it gets confusing, you can always use W3LL as a resource to compare and enroll in an ACA health insurance plan.

Providing Proof of Enrollment for ICHRA Participation

Once you have successfully enrolled with a health insurance plan, your next step is to provide proof of coverage to your employer. With that proof, you can then opt-in to your company’s ICHRA and begin submitting receipts for reimbursement. Be mindful of any other participation requirements your company might have, including signatures.

3. Submitting Receipts for Reimbursement

You’ve explored the ICHRA plan your company offers and have successfully enrolled in an ACA Marketplace health plan. Now you’re ready to start using those health and wellness coverage options and submitting receipts for reimbursement of those costs. Here’s how you can make the absolute most of your reimbursement advantages.

Know the Definitions

You might already know what’s covered and what’s not with your company’s ICHRA. But there are other definitions and guidelines you’ll likely need to follow, as well. Your employer might have defined what constitutes a valid receipt, for example, with instructions for digital or paper submissions. There might also be other terms in the policy that are new to you. Make sure you understand everything in the ICHRA language.

Know the Submission Process

You’ll also want to know and understand the receipt submission process. Your employer will have an outline, whether internal through an HR department or online via an employee-facing dashboard, regarding how and when to submit. Some healthcare services might require supporting documentation, and some might suffice with a simple receipt of payment via invoice statements.

Know the Reimbursement Timeline

The reimbursement timeline will also be key in managing your health expenses. Know how much time you have to submit a receipt. And have a general understanding of how your employer plans to process those reimbursements. Some companies issue payments directly while others roll ICHRA reimbursements in with existing expense reporting processes or payroll. You’ll have a better handle of your health-related expenses overall when you can rely on a routine schedule or timeline for ICHRA reimbursements.

If your employer is transitioning to an ICHRA, these are the employee steps to take first. And if you’re like others already leveraging the many benefits of an ICHRA platform, you’ll appreciate the control you’ll have over your health, the easy-to-predict nature of expenses, and the more innovative and affordable approach to health and wellness. It’s an employee benefit you’ll be glad to have in 2022. And W3LL is always here to help make the transition easier and more efficient.

Pete English

With nearly two decades in health insurance, Pete English’s diverse experience makes him uniquely qualified to help health plans and brokers leverage innovative technology in partnership with W3LL. From growing sales staff by 126% over 4 years at a large health plan, to building his own health insurance brokerage firm with over $7.2MM in annualized premium, Pete has done it all.

(631) 681-4898
PEnglish@w3ll.com