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Excited about getting a company’s ICHRA set up and introduced to employees? They’ll appreciate the reimbursement model far more than the one-size-fits-all, often costly, group health plans of years past.

But before rolling out the official announcements , prepare for commonly asked questions. Since an ICHRA will be new to employees, they will likely have plenty of questions or concerns about how they can benefit and use an ICHRA. Consider preparing a library of dedicated resources to help guide them through their required next steps for ICHRA participation. And include answers and explanations for these three most common employee questions.

Questions About Costs and Affordability

Expect participating employees to have questions about costs and affordability. Because they’ll be required to interact with the ACA Marketplace, maybe for the first time, they’ll need help to determine affordability. To be eligible for an ICHRA, employees need to prove enrollment in an affordable plan, meaning the remaining amount a staff member will have to pay for a self-only silver plan via the ACA is less than 9.61% of that member’s household income for 2022.

Consider providing the affordability calculator as part of the company’s resource library. Here’s an example:

An hourly employee, on average, works 130 hours each month. Even if they’ve worked more, using the 130-hour benchmark is the minimum allowed by ACA as full-time. Multiply those monthly hours by the person’s hourly pay rate. Then multiply by the affordability percentage.

 Affordable HRA Contribution > Lowest Cost Silver Plan = (9.61% * Employee Household Income)

Some employees might be concerned about the family glitch whereby household income levels allow for self-coverage but deem family coverage unaffordable. Prepare to answer these questions by sharing the latest in changing this dynamic so ICHRA participants can enroll in family coverage via the ACA, with premium tax credits, and within affordability guidelines.

How to Enroll and Transitioning to the ACA Marketplace

Another set of FAQs employers can expect from employees centers around transitioning to the ACA Marketplace and selecting a plan. Health insurance is complicated, and employees might need help understanding the various requirements and coverage options. Gaps in coverage can be avoided once employees are armed with all the relevant information and step-by-step guidance needed to enroll in the best plans.

Here are some common enrollment questions to expect:

  • How much time do I have available to make an enrollment selection?
  • How do I distinguish between bronze, silver, gold, and platinum plans?
  • Where do I go for help understanding coverage?

W3LL continues to pursue efforts in requesting the need for literature to simplify a transition to the ACA. And we can be a resource for staff who need a little help browsing and understanding the various plans, costs, and coverage options within the Marketplace. Consider providing basic definitions, terms, and conditions to help answer employee questions as they begin to make the transition .

How Reimbursements Work

Probably the biggest roster of questions an employer can expect when rolling out an ICHRA involves reimbursements. Employees will be new to the concept and likely have questions about what distinguishes an eligible reimbursement from a non-eligible one. They’ll want to know about the process for submitting, and timelines to payout of said reimbursements, as well.

Detail the specifics, including what types of expenses are the responsibility of the employee vs. the sponsoring employer. Detail what options employees have to recoup their reimbursements, whether direct payment, as part of payroll, or debit cards. And be transparent about the timelines for reimbursement.

Don’t forget to include information to help answer any questions about the tax advantages of participating in a company’s ICHRA. Employees will receive their tax-free payments from employers. They can also make pre-tax payroll contributions to help offset their ACA health insurance premiums. These tax advantages, along with the premium tax credits employees can leverage through the Marketplace, will only reinforce the increased affordability of the ICHRA model.

Preparing ahead of time to address common employee questions will ensure your teams have all the resources they need right at their fingertips to make the best coverage decisions. And armed with the details and guidance they need will help them see and reap the benefits of your company ICHRA.

If you need more help preparing to launch your ICHRA, let W3LL help! We can assist with addressing your questions, along with those of your participating staff, to make the most of your ICHRA. And as a third-party administrative partner, W3LL can help you manage your ICHRA with metrics, reimbursement processes, and compliance.

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

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