The Individual Coverage HRA notice: what are the requirements?

By: Jordan Berkenpas, NDG Guest Contributor 

The Departments of the Treasury, Labor, and Health and Human Services (the Departments) released information regarding the individual coverage HRA (ICHRA) notice requirements earlier this year.

The notice, which must be sent to all eligible employees 90 days before the benefit is offered, is primarily intended to inform eligible employees of how the ICHRA affects premium tax credits. This information will help employees make an informed decision on whether to participate in the ICHRA or opt-out. It also notifies employees that a benefit is being offered and what they can expect from the ICHRA.

This post will cover everything your ICHRA notice needs to include so that you’re offering the benefit in a compliant way.

When offering an ICHRA an employer must provide notice including the following:

• A description of the terms of the ICHRA. This should include the maximum dollar amount available for each participant in the HRA, which family members (if any) are included in the benefit, and whether the allowance amount will vary based on family size or age. The terms should also indicate the date in which coverage will first become effective and what date the plan year begins and ends. The notice must also provide information on when amounts will be made available (for example, monthly or annually). If the allowance does vary based on family size, the notice should clearly indicate the amount provided for a single individual. That’s the amount employees will use to determine affordability, which is a major component of determining premium tax credit eligibility under an ICHRA.
• A statement of the right of the participant to opt-out of and waive future reimbursement under the HRA. This should make clear to the employee that they have the ability to opt-out or decline the benefit. Be sure to inform them how and when they should opt-out of coverage. It’s best practice to have the employee advise in writing they were offered the benefit and are choosing not to accept it.
• A statement on how the ICHRA will affect premium tax credit (PTC) availability, whether the employee opts out or chooses to accept the benefit. If an employee accepts the benefit, they lose the option of utilizing a PTC. If an employee opts out and the ICHRA offering is deemed unaffordable, they may qualify for a PTC depending on income and other eligibility factors. If an employee opts out and the ICHRA coverage is deemed affordable, they won’t qualify for a PTC.
• A statement that the participant must inform any Exchange to which they apply for APTC (advanced premium tax credit) of certain relevant information. This should notify the employee to disclose the ICHRA offers when applying for coverage on the Exchange. That will allow the Exchange to determine if they’re eligible for a tax credit.
• A statement about how the ICHRA differs from other HRAs. The notice should contain a description of what the ICHRA is. It should also provide clarification that there other types of HRAs and that the plan being offered is not a QSEHRA, or any other type of HRA.
• A statement about the availability of a SEP for employees and dependents who newly gain access to the HRA. The requirements state that employees must be notified that they gain access to a special enrollment period (SEP) when they are newly offered the HRA. If an ICHRA starts on a date other than January 1 or if an employee is newly hired during the plan year, they can enroll in individual health insurance coverage outside of open enrollment using a SEP. If an employee becomes eligible for an ICHRA that would start at the beginning of the plan year, they’ll need to enroll in an individual coverage plan within the 60-day period before the first day of the plan year. If an employee becomes eligible for HRA coverage that would start mid-year (as with a new employee, or an employee with a change in hours), they may enroll in individual coverage up to 60 days before the first day that their ICHRA can begin, or up to 60 days after this date.
• A statement about how the participant can find assistance for determining their individual coverage HRA affordability. The Exchange website will provide information on how the employees can determine affordability under the ICHRA. They can find the exchange in their state here.
• A statement that the ICHRA can be integrated with Medicare. Employees must be informed that Medicare can be integrated with the ICHRA. The statement must also disclose that Medicare beneficiaries are ineligible for a premium tax credit, regardless of whether the ICHRA the individual is offered is affordable, provides minimum value, or whether the individual opts out of the HRA.
• Contact information of an individual or a group of individuals who participants can contact with questions regarding their ICHRA. The notice must include, at least, a phone number of an individual or group that participants may contact with questions about the ICHRA. The employer is allowed to determine who is best suited to help the participants.

Note: Per the Departments, for ERISA-covered plans, other disclosure requirements may require participants to be provided with a reasonable opportunity to become informed of their rights and obligations under the ICHRA.

When must the notice be provided?

For new ICHRAs, including those starting January 1, 2020, businesses must adhere to a 90-day notice requirement. That means that 90 days before the ICHRA’s start date, they must send employees a notice including each of the components above and notifying them of their eligibility for the benefit. For a plan starting on January 1, 2020, businesses must provide notice to employees on or before October 3, 2019.

The 90-day notice must be provided every year your business chooses to offer the ICHRA.

For newly eligible employees (newly hired employees or employees who gain eligibility after the initial start of the plan year), the timing is different. Your business can provide the notice up until the first day the employee’s ICHRA coverage begins. It’s best to provide notice as soon as possible, so the employee has ample time to review coverage options and enroll in a plan.

Conclusion

The Departments have provided a model notice that employers can use as a template for their notice. It’s not required that you use the model, but the Departments have advised the use of the model is sufficient for good faith compliance of the requirements as long as it’s provided within the correct time frame. Whether you use the model or not, be sure to include each of the requirements listed above and send the notice within the 90-day notice period.

For more information about offering the ICHRA, be sure to read: 15 FAQs on the individual coverage HRA (ICHRA).

This article was originally published on the PeopleKeep Blog.

Jordan Berkenpas is the customer advocacy marketing specialist with PeopleKeep. Starting out on the customer support team, Jordan developed a passion for small businesses and the PeopleKeep product that allowed him to transition into marketing. Jordan is a thought leader in the health care policy space, covering important topics related to the QSEHRA, ICHRA, and industry regulations.