guides & resources
Remodel Health ICHRA Enrollment Guide
Your Partner in Navigating Healthcare Benefits
Remodel Health has been revolutionizing health benefits delivery for nearly a decade. Powered by our proprietary software and backed by a team of licensed health benefits experts, we provide individualized health benefits solutions tailored to businesses of all sizes, nonprofits, educational institutions, and beyond. Our unwavering commitment to exceptional customer service ensures every client experiences the best in the industry.
Overview
What to Expect
Our Onboarding Process
At Remodel Health, we pride ourselves on providing customers with a pleasant, simple, and supportive onboarding process. We help organizations transition from traditional group health plans to a managed individual method. Employees and their families can explore various individual health plans that cater to their unique needs and budget.
One key aspect that sets Remodel Health apart is our personalized approach to onboarding. We provide a dedicated team member to guide employees and employers through each phase of the onboarding journey. This means a knowledgeable and friendly expert will offer tailored support and guidance every step of the way. From the initial introduction to our software platform to becoming thoroughly acclimated, our team provides the necessary support to make the transition as smooth as possible. Our commitment to individualized attention ensures that every question is answered and every concern is addressed, providing confidence and support during the integration into our system.
Overview
Who is
Remodel Health?
A Dedicated Team of Licensed Health Benefits Experts
At the core of Remodel Health is our dedicated team of licensed health benefits experts, committed to helping employers and employees navigate the complexities of individual health plans and programs.
What sets us apart is our white-glove service, offering personalized, hands-on support throughout the year. From the initial consultation to ongoing assistance, our experts provide tailored guidance at every stage, ensuring employers are supported and employees feel empowered. We aim to redefine health benefits by delivering customized solutions that enhance employee well-being and elevate the workplace experience.
Remodel Health is a transformative platform that leverages innovative software and comprehensive services to help organizations design and implement effective health benefits strategies. Our technology platform empowers employers to make informed decisions, prioritizing employee well-being while optimizing resource management.
Introducing the Implementation Team
Launch Coordinators
Implementation Project Managers
Launch Coordinators are dedicated specialists assigned to the organization, acting as project managers throughout the ICHRA implementation. Focusing on guiding admins through payroll integration, they ensure a seamless setup of the health benefits strategy. In addition, Launch Coordinators lead customized employee education sessions, equipping the workforce with a clear understanding of their new benefits. They aim to smooth the transition and ensure the team is confident using the Remodel Health platform effectively.
Benefits Advisors
Provide Employees Assistance
Benefits Advisors are licensed experts who advise employees who need assistance selecting a health plan. They are well-versed in the intricacies of individual health plans and are dedicated to helping employers and employees make informed decisions. Benefits Advisors offer personalized advice on selecting the best health plans, considering coverage options, prescriptions, networks, preferred providers, cost efficiency, employee needs, and unique situations. They will answer questions, address concerns, and ensure that employees fully understand their benefits and how to utilize them effectively.
Summary
Ensuring Implementation Runs Smoothly
Together, Launch Coordinators and Benefits Advisors form a powerful team that ensures the organization successfully implements the Remodel Health software platform and maximizes the value of its health benefits strategy. Their combined expertise and personalized approach are key components of the white-glove service that we proudly offer.
Year-Round Services
Ongoing Support
Onboarding with Remodel Health is just the beginning. Our commitment to employee success extends well beyond the initial steps. We offer year-round support and service, including assistance in navigating and optimizing health plans and addressing any questions. We’re here to guide employees every step of the way—so they never have to be alone in their healthcare journey.
Account Management
Remodel Health assigns a dedicated account manager to provide continuous support and address any issues. They will work closely with the organization’s leadership team and broker to ensure ongoing compliance and that the benefits strategy meets its goals. They’ll also manage any necessary strategy adjustments and guide the employees through yearly renewals, providing expert oversight to keep everything running smoothly.
Customer Success
Remodel Health assigns a dedicated customer success representative to provide ongoing, year-round support. They’ll are the go-to source for questions or issues, ensuring smooth administration and peace of mind throughout the year.
Understanding Individual Plans
Individual Plans Overview
Remodel Health revolutionizes employee benefits with Individual Coverage Health Reimbursement Arrangements (ICHRAs), offering a personalized approach distinct from traditional group plans. Unlike traditional group plans, which provide a one-size-fits-all package, Remodel Health empowers employees to choose individual health insurance plans tailored to their unique needs, funded by employer contributions. This flexibility enhances employee satisfaction and helps organizations control costs and comply with regulations more efficiently. Remodel Health’s innovative solutions simplify administration, providing user-friendly tools and expert support to streamline the process.
Available Plan Types
The following are different types of plans available with an ICHRA on the Marketplace, and they have other advantages.
High-Deductible Health Plan (HDHP)
This type of plan has a higher deductible and lower premium. It often pairs with a Health Savings Account (HSA), allowing employees to save pre-tax money for medical expenses. HDHPs are suitable for those who want to save on premiums and are prepared to pay more out-of-pocket for medical expenses until the deductible is met.
Copay Plans
These plans require paying a fixed amount (copay) for certain services, such as doctor visits or prescriptions, while the insurance covers the rest. They usually have lower deductibles and are beneficial if individuals prefer predictable costs for routine services
Network Plans
These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs). They define a network of healthcare providers individuals can visit.
How Networks Work
Networks are groups of doctors, hospitals, and other healthcare providers that have agreed to provide medical services to a health insurance plan’s members at negotiated rates.
In-Network Providers
These providers have contracts with the insurance company to offer services at lower, agreed-upon rates. When an individual visits an in-network provider, the insurance covers a significant portion of the cost, resulting in lower out-of-pocket expenses through reduced copays, co-insurance, and deductibles.
Out-of-Network Providers
These providers do not have contracts with the insurance company, allowing them to charge higher rates for their services. If an individual visits an out-of-network provider, their insurance may cover only a smaller portion of the bill or none at all, resulting in higher out-of-pocket expenses.
Why Networks Matter
Cost, Quality, and Predictability
- Cost Savings: In-network providers have agreed to charge lower rates, which helps control healthcare costs for the insurer and the insured.
- Quality Assurance: Insurance companies often review and select in-network providers based on quality standards, ensuring individuals receive care from reputable providers.
- Predictability: Using in-network providers makes it easier to predict their medical expenses, as they’ll know their copays, co-insurance, and deductibles in advance.
In-Network vs. Out-of-Network
Cost, Copay, and Deductibles
When an individual visits an in-network provider, they benefit from lower costs because the provider has agreed to accept the insurance company’s negotiated rates. The insurance typically covers a larger portion of the bill, resulting in lower out-of-pocket expenses, including reduced copays, co-insurance, and deductibles.
In contrast, choosing an out-of-network provider may lead to reduced insurance coverage or none at all, resulting in higher out-of-pocket costs. Individuals are likely to face higher deductibles and co-insurance rates and may even be billed for the difference between the provider’s charge and what the insurance is willing to pay, a practice known as balance billing. This can result in significantly higher medical expenses.
Individuals must seek in-network care to maximize savings and avoid unexpected expenses. The Remodel Health software platform allows employees to look up and select their preferred healthcare providers, ensuring their plan is optimized for both cost and convenience. This step is essential to fully leveraging their health benefits and getting the most value from their plan.
Common Health Insurance Terms
Glossary of Terms
Understanding common health insurance terms is essential for confidently navigating health benefits. This glossary defines key terms one may encounter throughout their health insurance journey with Remodel Health.
- Health Reimbursement Arrangement (HRA) – This employer-funded plan reimburses employees for qualified medical expenses, such as insurance premiums and out-of-pocket costs. Employers determine the contribution amount, and employees can use these funds to cover healthcare expenses, often without paying taxes on the reimbursements. HRAs offer flexibility for both employers and employees.
- Individual Coverage Health Reimbursement Arrangement (ICHRA) – This employer-funded health benefit allows employees to purchase their own individual health insurance plans. Employers provide a set allowance, and employees can use those funds to reimburse premiums and other qualified medical expenses, offering a customizable alternative to traditional group health insurance.
- Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) – This HRA is designed for small businesses with fewer than 50 full-time employees. It allows employers to reimburse employees tax-free for individual health insurance premiums and qualified medical expenses, providing a flexible health benefit without a traditional group health plan.
- Metal Levels – These are categories of health plans available on the Health Insurance Marketplace, each representing a different level of coverage and cost-sharing. The levels—Bronze, Silver, Gold, and Platinum—indicate how costs are split between the insurer and the insured. Bronze has the lowest premiums and higher out-of-pocket expenses, and Platinum offers the highest premiums but the most comprehensive coverage.
- Preventative Coverage – This refers to health insurance benefits that cover routine healthcare services to prevent illnesses or detect health issues early. These include vaccinations, screenings, and annual check-ups, typically provided at no cost to the insured when delivered by in-network providers.
- Premium – This is the monthly amount an individual pays to maintain their health coverage. Whether or not they use any healthcare services, paying this amount is required to ensure their insurance policy remains active.
- Ancillaries – These supplemental benefits go beyond basic medical coverage, such as dental, vision, and life insurance. These additional services enhance the overall health package, offering more comprehensive care options for employees.
- Deductible – A deductible is the amount an individual pays for covered healthcare services before their insurance begins to contribute. After meeting the deductible, they typically pay only co-payments or co-insurance, with the insurance covering the remaining costs.
- Co-Insurance – This is the percentage of the cost of a covered healthcare service an individual pays after meeting their deductible. For example, if the co-insurance rate is 20% and the allowed amount for a service is $100, the individual pays $20, and the insurance covers the remaining $80. However, not all plans have co-insurance.
- Out-of-Pocket Maximum – This is the most an individual must pay for covered services in a plan year. After reaching this amount through deductibles, co-payments, and co-insurance for in-network care, their health plan covers 100% of the costs for covered benefits.
- Health Savings Account (HSA) – This medical savings account is available to those enrolled in a high-deductible health plan (HDHP) as determined by the IRS. The funds contributed to an HSA are not subject to federal income tax and can be used for qualified medical expenses.
- Copay – This is a fixed amount of money that an individual pays out-of-pocket for a specific medical service or prescription when receiving it, while health insurance covers the remaining cost. This predetermined fee is part of the health insurance plan and helps share the expense between the individual and the insurer.
Additional Resources
Included below are introductory videos explaining health insurance terminology.
What is a Qualifying Life Event /
Special Enrollment Period (SEP) ?
The 4 Types of QLEs
A Qualifying Life Event (QLE) is a significant change in circumstances, such as a change of address, getting married, having a baby, or losing health coverage. These events can make individuals eligible for a Special Enrollment Period (SEP), allowing them to enroll in health insurance outside the standard Open Enrollment Period.
1. Loss of Health Coverage
- Losing existing health coverage, such as job-based, individual, or student plans.
- Losing eligibility for Medicare, Medicaid, or CHIP.
- Turning 26 and losing coverage through a parent’s plan.
2. Changes in Household
- Getting married or divorced.
- Having a baby or adopting a child.
- Losing a family member.
3. Changes in Residence
- Moving to a different ZIP code or county.
- Students move to or from the place where they attend school.
- Seasonal workers move to or from where they live and work.
- Moving to or from a shelter or other transitional housing.
4. Other Qualifying Events
- Gaining membership in a federally recognized tribe or becoming an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
- Becoming a U.S. citizen.
- Leaving incarceration (jail or prison).
- AmeriCorps members starting or ending their service.
Special Enrollment Period (SEP)
A Special Enrollment Period (SEP) is a time outside the annual Open Enrollment Period when an individual can sign up for health insurance. Individuals become eligible for an SEP if they experience certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child. Additionally, they may qualify for an SEP if their household income falls below a certain level. Depending on the type of Special Enrollment Period, they typically have 60 days before or after the event to enroll in a health plan. Individuals can apply for Medicaid and the Children’s Health Insurance Program (CHIP) anytime, but it must be done independently.