What Types of Health Insurance Costs Can Be Paid for With ICHRA Benefits?

Individual Coverage Health Reimbursement Arrangements (ICHRAs) are fast becoming a popular and affordable choice for companies to offer their employees. But it’s not a health insurance product directly. If you are new to an ICHRA with your current employer, you may have questions about what kind of health insurance can be covered with an ICHRA benefit. And what kind of expenses are you eligible for reimbursement? Today, we’ll take an even deeper dive into how ICHRAs work and what they’re typically designed to offer.

What Most ICHRA Benefits Cover

Because there are different types of HRAs, there are variances to what benefits are covered as part of the reimbursements. Other key factors are the guidelines set forth by each specific company and employer. Because the HRAs are owned and facilitated by the employer, there are some nuances to expect across the different benefits allowances. However, in general, and with the ICHRA model, there are some costs you can bank on being covered.

Medical Costs
Any costs you pay out of pocket directly to your healthcare providers will likely be reimbursable with the ICHRA benefits. An annual checkup with a physician might require additional lab work or scans. Your insurance may cover some of these costs, but typically after the deductible is met. So those costs that end up being your burden can, in turn, be submitted and reimbursed to you via the ICHRA your employer offers.

Dental Costs
Dental charges are also under the general umbrella of reimbursable costs. These bills can get lofty, especially if you have several covered members in your family getting routine checkups. Office visits, cleanings, x-rays, and fillings will all present invoices that can be reimbursed under the benefits of the ICHRA.

Vision Costs
If you or other family members covered under your health insurance plan have glasses or contacts, you’ll be glad to know that most ICHRA reimbursement platforms include out of pocket costs for vision care. Routine visits may not be a huge burden. But when you or others need contacts, replacement lenses, or prescription sunglasses, the bills can add up fast.

Health Insurance Premium Reimbursements

As previously mentioned, not every HRA is set up the same, and employers may have differing guidelines for what is considered reimbursable or not. It’s always best to check with your employer directly for specific allowances and benchmarks. However, the ICHRA benefits can often include insurance premiums you pay monthly to secure coverage through a Marketplace plan.

Short-Term Health Insurance
If you select to enroll in a short-term health insurance plan, the premiums you pay for those few months without coverage can often be reimbursed with an employer-sponsored ICHRA. Most individuals elect the short-term plans because of a lapse in benefits coverage, to bridge a gap between plans. Others who consider themselves relatively healthy, like the short-term health insurance plans for their reduced costs premiums. In either scenario, getting reimbursed for those premiums is a great benefit.

Dental Insurance Premiums
Just as your ICHRA plan can reimburse you for out of pocket dental costs, it is also possible to be compensated for dental insurance premiums you pay for coverage. Check with your employer contact for benefits explanations to verify. However, in general, these monthly premiums are reimbursable.

Vision Insurance Premiums
Any vision insurance you pay for through the Marketplace or otherwise may also qualify as a reimbursable expense. As with other questions, you can verify with your employer or ICHRA benefits coordinator for details. But knowing these premiums, in addition to the out of pocket costs for visits and eye care, are potentially reimbursable can be a huge benefit for those who use these services.

Important ICHRA Requirements

Before you can leverage any company-sponsored ICHRA reimbursement benefits, there are few requirements you need to meet first. Your employer or ICHRA benefits coordinator can help you with specific questions about your plan. However, for the most part, these guidelines apply to most ICHRA platforms.

You Must Have a Marketplace Health Insurance Plan
To qualify and take advantage of your company’s ICHRA benefits, you must first subscribe and enroll in a health insurance plan. You can browse the Marketplace and select a plan or with private sector companies, if necessary. The Marketplace only allows enrollment during the open enrollment period at the end of each year. But there are circumstances that will enable you to take advantage of a special enrollment period.

Understand Your Company’s Process
Each business that adopts an ICHRA benefits platform can either set up the process internally or outsource to a third-party benefits coordinator. Your employer will ultimately set up a specific process that may include a dashboard for reimbursement submissions and tracking. But others may have different requirements for participation. Inquire with your company’s human resources department or benefits contact for details and important timelines you’ll need to know.

Submitting Required Expense Receipts
While there are general practices for ICHRAs, your company may have a unique process for submitting and qualifying expenses. You’ll need to inquire to understand yours. However, most companies accept an actual invoice from a provider or an explanation of benefits from the health insurance company as proof. Your timeline to reimbursement may vary and will often be paid along with a regular pay schedule.

If you have received a notice or communication from your employer about a company-sponsored ICHRA benefits platform, you will want to be sure to understand the precise setup, enrollment, and submission terms. But for most of those who already leverage the many reimbursement benefits of an ICHRA plan, it’s a great option to help control healthcare-related costs out of pocket. And most employees learn to appreciate only having to pay for what services they render and receiving reimbursements for those exact costs.

If you need help understanding where to begin or need to enroll in a Marketplace health insurance plan because of an ICHRA plan at work, browse with W3LL. A few quick and easy questions can help you get started, and our free service allows you to sort and compare health insurance plans.