Can I pay the PCORI fee electronically?

Yes, you can pay the PCORI fee electronically. You can use the Electronic Federal Tax Payment System (EFTPS).

Do I owe a PCORI fee if I offer both an ICHRA and a group health plan?

Yes, you need to pay a PCORI fee if you offer an ICHRA. The PCORI fee for ICHRA is separate if the group plan is a fully-insured plan, as PCORI only applies to self-funded models. If you offer a self-funded plan alongside an ICHRA to different employees, and they share the same plan year, you can combine them for PCORI fee reporting purposes. Count the average number of participating employees and dependents for the self-funded plan plus the average number of participating ICHRA employees.

Is a QSEHRA worth it for small businesses?

For many small businesses, yes, a QSEHRA is worth it. A qualified small employer HRA (QSEHRA) offers a predictable way to provide health benefits without the cost and complexity of traditional group health insurance. Employers set a monthly allowance that fits their budget, while employees choose their preferred individual health insurance plan.

What are some potential drawbacks to consider when thinking about offering a QSEHRA?

The main potential downside to a QSEHRA is the IRS annual contribution limit. Unlike an individual coverage HRA (ICHRA), employers can't give employees more than the IRS-set maximum limit. QSEHRAs also have fewer customization options for varying employee contributions.

Can employees choose any health insurance plan with a QSEHRA?

Yes. Employees can generally purchase any ACA-compliant individual health insurance plan that best meets their needs through a local exchange, the federal Health Insurance Marketplace, a private insurer, or a licensed insurance broker. However, employees must have a health plan that provides minimum essential coverage (MEC) to participate in the QSEHRA.

Who is eligible to offer a QSEHRA?

A QSEHRA is available to employers with fewer than 50 full-time equivalent employees (FTEs). You can’t offer a traditional group health plan or group ancillary benefits alongside the QSEHRA. Employers must also comply with IRS rules regarding reimbursement limits and employee eligibility.

Can a QSEHRA reimburse more than individual insurance premiums?

Yes. Employers can design the benefit to allow employee reimbursements for health insurance premiums only or for premiums plus other IRS-qualified out-of-pocket medical expenses. This includes deductibles, copays, over-the-counter drugs, prescription medications, and other eligible expenses.

Can I administer a QSEHRA myself?

While employers can self-administer a QSEHRA, doing so can be time-consuming and risk compliance penalties. Many employers use an HRA administrator, like PeopleKeep, to automate plan documents, review reimbursement requests, maintain required records, and help ensure compliance with IRS and HIPAA requirements.

Why is employee engagement important for health benefits?

Employee engagement helps ensure workers understand, use, and appreciate the health benefits available to them. When employees participate in their benefits program, employers often see higher job satisfaction, better retention, and a stronger return on their benefits investment.

How can employers increase participation in health benefits?

Employers can increase participation by communicating regularly, educating employees about their options, offering personalized benefits, creating wellness initiatives, providing incentives, and gathering employee feedback. These strategies help employees better understand and use their benefits.

How do HRAs improve employee engagement?

Health reimbursement arrangements (HRAs) give employees more choice and flexibility by allowing them to select the individual health insurance coverage that best fits their needs. This personalized approach can increase benefit utilization and employee satisfaction while helping employers control healthcare costs.

An individual coverage health reimbursement arrangement (ICHRA) is an employer-sponsored benefit that allows organizations to provide tax-free contributions employees can use toward individual health insurance premiums and eligible medical expenses. Unlike traditional group health plans, ICHRA gives employees more flexibility to choose coverage that fits their needs.

Is ICHRA only for small employers?

No. Employers of all sizes use ICHRA to provide flexible health benefits.

Do employees have fewer health plan options with ICHRA?

No. ICHRA often gives employees access to a wider range of individual health plans. Instead of choosing from a limited number of employer-selected group plans, employees can compare available options and select healthcare coverage based on their providers, prescriptions, budget, and healthcare needs.

Can an employer switch ICHRA administrators midyear?

Yes. Employers can transition administrators midyear. However, switching administrators doesn't trigger a special enrollment period (SEP) for employees.

What information do I need from my current ICHRA administrator when changing partners?

Employers should request a complete enrollment file, including employee and dependent details, plan IDs, member IDs, contribution amounts, and payment information.

How long does an ICHRA administrator transition take?

The timeline depends on the size of the group, carrier processes, available data, and whether employees are making plan changes. A strong transition partner will help create a clear timeline and guide employers through each step.

Will switching ICHRA administrators affect my employees’ health plans?

It depends on the timing of an ICHRA vendor change. If you’re exploring a midyear change, employees’ plans won’t be impacted, as changing ICHRA vendors doesn’t create an SEP. However, changing vendors during the annual Open Enrollment period would allow employees to change their plans for the new benefit year.

What should I look for in an ICHRA administrator?

You should look beyond tech-only ICHRA platforms and evaluate vendors based on their customer service model, compliance support, and change management.

What is the difference between Medicaid and CHIP?

Medicaid provides health coverage for eligible low-income individuals and families, including adults, children, pregnant individuals, seniors, and people with disabilities. In contrast, CHIP is primarily for children and certain pregnant individuals whose household income is too high to qualify for Medicaid but too low to comfortably afford private health insurance.

Can you have Medicaid and private health insurance at the same time?

Yes. In some situations, individuals can have Medicaid and another form of health insurance simultaneously. When this happens, Medicaid may help pay for certain medical costs the primary insurance plan doesn’t cover. However, coordination of benefits rules may vary depending on the type of private coverage the individual has and their state requirements.

What income levels qualify for Medicaid?

Medicaid income limits vary by state, household size, and eligibility category. Most states use modified adjusted gross income (MAGI) to determine eligibility for children, parents, and many adults. In states with Medicaid expansion due to the Affordable Care Act (ACA), adults with household incomes up to 138% of the federal poverty level may qualify.

Can adults qualify for CHIP?

CHIP is primarily for children younger than age 19. However, some states allow certain pregnant individuals to qualify for CHIP coverage.

Can employees with Medicaid participate in an ICHRA?

No. While Medicaid counts as minimum essential coverage (MEC), the federal government doesn’t consider it qualifying individual health insurance, which is necessary to participate in an ICHRA. Employees must enroll in an eligible individual health plan to use their ICHRA benefit.

Does an ICHRA affect CHIP eligibility?

It can. A child's eligibility for CHIP may depend on whether the employee's ICHRA meets affordability standards. Because CHIP rules differ by state, employees should contact their state's Marketplace or Medicaid agency to determine how an ICHRA offer affects their family's eligibility.