Premium Reimbursement Rules: What Can Be Reimbursed and What Cannot?
Under an Individual Coverage Health Reimbursement Arrangement (ICHRA), employers decide which expenses are eligible for reimbursement. You may choose to reimburse: Individual health insurance premiums only, or Both premiums and qualified medical expenses (as defined by the IRS) Your elections must be documented in your ICHRA plan documents and communicated to all eligible employees. Option […]
ICHRA and COBRA: Employer Obligations After an Employee Loses Eligibility
When an employee covered under an Individual Coverage Health Reimbursement Arrangement (ICHRA) loses eligibility — typically due to termination of employment — employers often ask whether COBRA applies. It is important to understand that ICHRA is fundamentally different from traditional group health insurance. Because employees purchase individual, employee-owned health insurance policies, COBRA continuation coverage does […]
Handling Special Enrollment Periods (SEPs) Triggered by ICHRA Offers
When you offer an ICHRA to your employees, you automatically trigger a Special Enrollment Period (SEP) that allows employees to shop for and enroll in individual health insurance plans outside of the traditional Open Enrollment window. This SEP is unique to ICHRAs and ensures employees can get coverage when their new benefit begins. This article […]
Do ICHRAs Meet the Affordable Care Act’s Employer Mandate?
The Affordable Care Act (ACA) requires that employers with more than 50 full-time equivalent employees provide health insurance to their employees. This is known as the ’employer mandate’. ICHRAs can meet the mandate as long as they are considered ‘affordable.’ An ICHRA is affordable if the employee’s share of the cost for the lowest-cost self-only […]
ICHRAs and Advanced Premium Tax Credits
Employees often ask whether they can use an ICHRA and still collect Advanced Premium Tax Credits (APTCs) on the Health Insurance Marketplace. The short answer is: Employees cannot use ICHRA funds and premium tax credits at the same time. However, employees may still be eligible for APTCs if your ICHRA offer is considered unaffordable. Refer […]
Affordability Rules for Applicable Large Employers (ALEs)
If your organization is an Applicable Large Employer (ALE) — meaning you averaged 50 or more full-time + full-time equivalent employees in the previous calendar year — you must meet the IRS’s affordability requirements when offering an ICHRA to any full-time employee. These rules fall under the Affordable Care Act (ACA) Employer Shared Responsibility provisions. […]
Can I Designate a Waiting Period for My Employees?
Yes — employers can designate a waiting period for new employees before they become eligible for an ICHRA. This is a common setup for groups that want benefits eligibility to align with sustained employment, onboarding milestones, or other internal policies. Employers can designate waiting periods of 30, 60, or 90 calendar days or decide not […]
Will BEN360 Help Me With Year-End Tax Reporting?
BEN360 will assist you with the preparation following forms: 1095- A 1095- B 1095- C PCORI Fee Please note: BEN360 is not a tax firm or accountant. We will provide you with the forms and information specifically related to ICHRA. Please consult a tax professional to complete other necessary year-end reporting. Note: in order for […]
More About Forms 1095-A, 1095-B and 1095-C
Form 1095-A Form 1095-A refers to the Health Insurance Marketplace Statement. It is provided by the Health Insurance Marketplace (either Healthcare.gov or the equivalent state-based exchange) to all enrolled individuals. Most employees participating in a BEN360 ICHRA will receive a 1095-A. Exceptions include individuals enrolled in a health insurance plan not connected with the Health […]
What is the PCORI fee? Does My Company Need to Pay It?
The Affordable Care Act requires that employers who offer an ICHRA or a self-insured health plan pay a fee to fund the Patient-Centered Outcomes Research Institute (PCORI). Employers must pay this fee as they file their IRS Form 720 in July. Every June, BEN360 will provide your expected PCORI fee and help you to prepare the IRS Form […]