Individual Coverage Health Reimbursement Arrangements (ICHRAs) are transforming how today’s businesses provide benefits to employees. Significant advantages to both the company’s bottom line as well as the individual worker’s coverage options make ICHRA an appealing transition. Under the ICHRA platform, employers control a reimbursement structure whereby participating employees can submit receipts for out-of-pocket costs.
What most employers appreciate most about the ICHRA coverage model is the flexibility to design a reimbursement model that aligns with their company’s specific parameters. Companies can develop a reimbursement platform based on unique employee preferences, available benefits budgets, and across several employee types. This means not all ICHRA policies are alike, and health insurance costs covered may vary by the business entity.
However, there are some expenses that typically qualify as eligible ICHRA reimbursements. Here are just a few of what employers and employees can expect to be covered under an ICHRA model.
When employers set up ICHRAs, they also set parameters around reimbursements, usually based on benefits budgets and employee types. Participating workers will need to verify what guidelines apply in their program to better understand what expenses they can submit for repayment.
There is a growing need for companies to ensure teams have workplace support in preserving their mental well-being. ICHRA provisions allow for reimbursements related to mental health care. From telehealth visits with a therapist to refilling anti-anxiety medication, companies can offer out-of-pocket reimbursements for employee mental health care.
Usually, over-the-counter remedies or everyday wellness toiletries aren’t covered under an ICHRA model. However, nearly every other provider prescribed medication does meet ICHRA reimbursement requirements. Many ACA Marketplace plans provide options that include prescription coverage. However, there are often out-of-pocket expenses due at the pharmacy counter that an ICHRA reimbursement can help cover for participating employees.
For qualifying participants, in households where a spouse’s plan doesn’t conflict with coverage, ICHRA reimbursements can help offset everything from a spouse’s out-of-pocket specialist visits to the kids’ school physicals. Employers may authorize reimbursements for dependents just as easily as they do for individuals.
If you’re interested in some of the more common expenses covered by an ICHRA reimbursement, CMS outlines a complete list of eligible expenses.
The ICHRA benefits will likely reimburse any out-of-pocket costs you pay to your healthcare providers. Additional lab testing or scans may be required for an annual checkup with a doctor. Although your insurance might cover some of these expenses after the deductible has been met, most of them will still have costs that remain the patient’s responsibility. As a result, those expenditures can be submitted for reimbursement under the ICHRA model.
Dental expenses also qualify as reimbursable costs under the ICHRA model. Office visits, routine cleanings, oral x-rays, and fillings will all be expenses that come with out-of-pocket costs that may be reimbursed under the ICHRA’s provisions on benefits.
If you or other family members covered by your health insurance plan need glasses or contacts, you’ll be relieved to learn that the majority of ICHRA reimbursement platforms include vision care expenses out of pocket.
One of the other benefits of an ICHRA offering is the possibility of submitting reimbursement requests for monthly premium payments. Employees leveraging ICHRA benefits should inquire about guidelines to make the most of these premium reimbursement opportunities. But imagine the added savings of finding an affordable ACA Marketplace plan with available tax subsidies and then receiving a reimbursement for the monthly premium as part of your ICHRA.
If you choose to enroll in a short-term health insurance plan, the premiums you pay for those few months without coverage are frequently eligible for reimbursement through an employer-sponsored ICHRA. Most people opt for short-term plans because of a loss of benefits coverage or to bridge a gap between plans.
Dental plans are available both via the ACA Marketplace and in the private market. These coverage plans make sense for individuals who need ongoing dental or orthodontic care. The premiums can, in some ICHRA platforms, also qualify as a reimbursable cost. These monthly out-of-pocket charges can run high, particularly if members have several covered members in the family who require regular dental care.
Vision insurance that you pay for through the Marketplace or otherwise may qualify as a reimbursable cost, according to several sources. You can check with your employer or ICHRA benefits coordinator for more information about what types of vision care out-of-pocket expenses apply.
When you’re ready to explore your ICHRA options, let W3LL help! We can guide you through everything from an employer perspective and as an employee leveraging the reimbursement benefits.
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.