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Need-to-knows about ICHRA substantiation requirements

Written by: Gabrielle Smith
March 10, 2021 at 8:18 AM

One of the biggest differences between the individual coverage health reimbursement arrangement (ICHRA) and other HRAs is that employees and their dependents are required to have their own individual health insurance policy in place in order to participate.

In this article, we’ll go over which types of individual insurance qualify, the steps employers need to take to make sure their employees and their dependents are insured, and how often to check their insurance status.

Which insurance plans are allowed under the ICHRA?

Not all coverage types are created equal. Employees and their dependents who plan to get medical expenses reimbursed need to be covered through a plan that can be integrated with the ICHRA.

Acceptable coverage types include:

  • Any individual health coverage insurance policy purchased on the open market, the Affordable Care Act (ACA) healthcare marketplace public exchange, or on a private exchange
    • All of these plans will work with the ICHRA so long as they cover the necessary essential health benefits with no annual or lifetime limits set forth by the ACA as minimum essential coverage.
  • Medicare
    • Medicare Part A and B, or C can be integrated with the Individual Coverage HRA and are eligible for premium reimbursements for Medicare Part A, B, C, or D, and Medigap policies, as well as related medical expenses.
  • Student health insurance policies
    • All student health insurance policies follow the ACA’s essential coverage rules, so it’s acceptable. However, self-insured student health coverage isn’t allowed since self-insured student plans are exempt from ACA coverage rules.

Unacceptable coverage types include:

  • Any kind of group health plan
    • This includes a group plan from a spouse or a parent.
  • Association health plans
  • COBRA
  • Health care sharing ministries
  • Self-insured student health plans
  • Short-term limited duration insurance
  • Tricare

How do employees submit proof of individual coverage?

According to ICHRA regulations, individual coverage can be substantiated through one of two ways at the discretion of the plan administrator, or employer.

1. Submit proof through a third-party

The first option is for the employee to submit proof of coverage directly to the employer through a third party, like their insurance provider or an exchange. This could be from an insurance card, explanation of benefits, or another document stating the employee (and any dependents) will have individual health coverage for the plan year.

2. Submit an attestation

The other option is for the employee to submit an attestation of coverage to the employer. That’s just a physical or electronic letter stating that the employee and their dependents will be enrolled in individual health coverage for the plan year. It should also include the date the insurance coverage begins as well as the name of the coverage provider.

When do employers need to check employees’ insurance status?

There are three periods when employers need to ensure their ICHRA participants have acceptable individual coverage:

Annual basis

Prior to the first day of each plan year, all employees and their dependents must fill out the Individual Coverage HRA Attestation: Annual Coverage Substantiation Requirement form to show proof of coverage.

Ongoing basis

Every time an employee submits a reimbursement request, they must also include a completed copy of the Individual Coverage HRA Attestation: Ongoing Substantiation Requirement form to go with it.

Individual basis

When you hire a new employee, or an existing employee becomes newly eligible in the middle of the year, they’ll need to submit the annual substantiation form before the ICHRA will take effect.

Do employers need to verify the information is accurate?

Here’s the nice thing about ICHRA’s regulations—as long as you, the employer, have no reason to believe that the information provided to you is false or misleading in any way, then you can safely assume the information is accurate. This takes the pressure off from verifying the validity of the documents you receive.

Conclusion

While managing a compliant ICHRA comes with quite a few rules and regulations, you don’t have to go it alone. PeopleKeep’s software and award-winning customer support team have helped thousands of organizations administer their health benefits in just minutes each month.

Check out our ICHRA product demo to see what we’re all about.

Topics: Health Benefits, Individual Coverage HRA, ICHRA

Additional Resources

Trying to decide which HRA is best for you? Take our quiz to find out.
Get our guide on how to offer health benefits with a small budget.

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