Certification

1. ICHRA participants must be enrolled in individual coverage (or Medicare).

All individuals eligible for reimbursement under the ICHRA must be enrolled in individual health coverage or Medicare and provide proof of that coverage. There is an annual substantiation requirement that applies prior to enrollment in the ICHRA, and an ongoing substantiation requirement that applies each time reimbursement is requested.

Do you have procedures in place to ensure that only those who provide adequate annual and ongoing substantiation of individual health coverage or Medicare are permitted to participate in and receive reimbursement from the ICHRA?

Yes No

2. The ICHRA must be offered on the same terms to all employees within a particular class.

If the ICHRA is not being offered to all employees, it must be offered to all employees within a specified class, generally on the same terms.

Do you have procedures in place to ensure that ICHRAs are offered on the same terms to all employees within a specified class or combination of classes?

Yes No

3. Employees offered the ICHRA cannot also be offered a traditional group medical plan.

If the ICHRA is offered within a class of employees, none of the employees within that class may also be eligible for the employer’s traditional group medical plan, if any. In addition, if an employer offers a traditional medical plan to some employees and an ICHRA other employees, minimum class size rules apply.

Do you have procedures in place to ensure that employees who are offered an ICHRA are not also offered a traditional group medical plan by the same employer?

Yes No

Do you have procedures in place to ensure the ICHRA meets minimum class size rules for employers who offer a traditional group medical plan to some employees and the ICHRA to other employees?

Yes No

4. The ICHRA may be designed to reimburse any §213(d) qualifying medical expenses, including individual health coverage and Medicare premiums.

An ICHRA may be available to reimburse premiums, §213(d) qualifying medical expenses other than premiums, or a combination of the two. If the ICHRA will reimburse §213(d) qualifying medical expenses other than premiums, participants must be required to submit proper third-party substantiation before being reimbursed (or, alternatively, follow debit card procedures already approved for other types of HRAs and health FSAs).

Have you decided which types of reimbursement you can handle and how reimbursement for such expenses will be facilitated?

Yes No

For premiums, have you decided whether you will pay the carriers directly, or require the premium payments be made by participants and then reimbursement requested?

We will pay the carriers directly We will require that premiums are payed by the participants We have not yet decided

For reimbursement of medical expenses other than premiums, do you have procedures in place to ensure that the ICHRA only reimburses eligible expenses for which proper third-party substantiation has been provided?

Yes No

5. ICHRA coverage options & ERISA safe harbor.

Most employees will need assistance navigating and enrolling in individual plan options. However, in order to avoid the individual health plans being subject to ERISA, the employer must not select or endorse any particular insurance carrier or coverage options, cannot receive any financial incentive, and must notify participants annually that the individual health insurance is not subject to ERISA. Individuals must be permitted to enroll in any qualifying individual health coverage, on or off-Exchange (i.e. the choice of plan must be completely voluntary).

Have you decided whether you will facilitate the purchase of individual health coverage as part of your product offering, find a partner who can provide such access or assistance, or require that individuals obtain individual coverage on their own?

Our product offering will help to facilitate the purchase of individual coverage We will use a 3rd party to help faciliate the purchase of individual coverage We will require that individuals obtain coverage on their own We have not yet decided the role we wish to play in the selection process

If choosing to facilitate the process, will your design meet the ERISA safe harbor?

Yes No I don't know

6. ICHRA Network Access & Affordability.

Employers and employees will need to understand the network access and cost/affordability of the individual coverage options. For affordability, there are several considerations:

Cost Comparison - Employers of all sizes will be interested in comparing the cost of individual coverage and group health plan coverage.
PTC Eligibility - Employers of all sizes will also need to understand and communicate to employees how the ICHRA offering may impact eligibility for a premium tax credit (PTC) through a public Exchange. An individual who is enrolled in the ICHRA or who is offered an affordable ICHRA will not qualify for a premium tax credit through a public Exchange
§4980H(b) Requirements - To avoid potential liability under §4980H(b), applicable large employers will need to ensure the ICHRA is affordable based on one of the affordability safe harbors (i.e. FPL, rate of pay, or Form W-2).

Have you decided whether you will advise or assist (e.g. provide tools) with network access and affordability determinations, or instead recommend that they coordinate such efforts with counsel or benefits advisers?

We will assist with affordability determinations We will recommend the benefits advisor assists with affordability determinations We have not yet decided if/how we will assist with affordability determinations

7. Participants must be able to opt out of coverage and waive future reimbursement.

Eligible participants must be given the option to opt out of ICHRA coverage and waive any future reimbursements in order to preserve PTC eligibility when applicable.

Do you have procedures in place to ensure that ICHRAs are designed to always allow individuals to opt-out of participation and waive any future reimbursements after terminating ICHRA coverage?

Yes No

8. An annual notice must be provided to eligible individuals.

Employees who are eligible to participate in an ICHRA must be provided with a notice at least 90 days before the beginning of each plan year, or, for those who become eligible later or enroll after the beginning of the plan year, no later than the employee’s effective date of coverage.

Have you decided whether you will assist employers with preparing and making the annual notice available to eligible individuals?

We will assist employers in preparing the annual notice We will not assist employers in preparing the annual notice We have not yet decided if we will assist employers with the annual notice

9. ICHRAs will likely require annual reporting.

An ICHRA is a self-funded group health plan that may require coverage reporting. In addition, applicable large employers will need data captured about offers of coverage, enrollment, and cost of coverage for IRS Form 1094-C and Form 1095-Cs.

Have you decided whether you will offer tools to track applicable data and assist in reporting coverage as well as offer of coverage information at the federal level and state level, if applicable?

We will assist employers in reporting coverage and offer of coverage We will not assist employers in reporting We have not yet decided if we will assist employers with reporting

10. Continuation Coverage – ICHRAs are group health plans subject to federal COBRA.

Employers with 20 or more employees must offer ICHRA to individuals who loses eligibility due to a qualifying event (e.g. termination of employment, reduction in hours, a dependent aging out, divorce).

Are you able to facilitate ongoing participation for those individuals who are offered and elect COBRA for the ICHRA?

Yes No

Have you decided whether you will advise or assist employers with setting COBRA premiums, or instead recommend that they coordinate such efforts with counsel or benefits advisers?

We will assist employers with setting COBRA premiums We will recommend that the employer works with their benefits advisor to set COBRA premiums We have not yet decided if/how we will assist with COBRA premiums

11. ERISA Documentation & Reporting – ICHRAs are group health plans subject to ERISA.

ICHRAs must have plan documentation, summary plan descriptions (SPDs) and a summary of benefits of coverage (SBC). The ICHRA may also be subject to annual Form 5500 reporting.

Have you decided whether you will advise or assist with plan documentation or Form 5500 filings as part of your product offering, or instead recommend that they coordinate such efforts with counsel or benefits advisers?

We will assist with ERISA documentation and reporting We will recommend the employer works with their benefits advisor We have not yet decided

12. HSA-Eligibility.

Reimbursement of §213(d) qualifying medical expenses, other than premiums or excepted benefits, prior to meeting the minimum deductible will make individuals ineligible to contribute to an HSA.

Have you decided whether you will advise or assist with designing an ICHRA that will be HSA-compatible, or instead recommend that they coordinate such efforts with counsel or benefits advisers?

We will advise on HSA compatibility We will recommend the employer work with their benefits adviser on HSA compatibility We have not yet decided if/how we will assist with HSA compatibility determinations

13. Nondiscrimination Rules – ICHRAs are self-funded group health plans subject to §105(h) nondiscrimination rules.

An ICHRA may differentiate amounts available by age or based on family size but cannot favor highly compensated individuals. If an employer also offers a self-funded traditional group medical plan, that plan must comply with §105(h) nondiscrimination rules. It might also be necessary to consider how the ICHRA offering impacts compliance with §125 nondiscrimination rules for cafeteria plans.

Have you decided whether you will advise and assist (e.g. perform discrimination testing) employers with understanding and complying with §105(h) and §125 nondiscrimination rules, or instead recommend that they coordinate such efforts with counsel or benefits advisers?

We will assist employers in complying with nondiscrimination rules We will recommend employers work with their benefits advisord on nondiscrimination issues We have not yet decided if/how we will assist with nondiscrimination

1. ICHRA participants must be enrolled in individual coverage (or Medicare).

2. The ICHRA must be offered on the same terms to all employees within a particular class.

3. Employees offered the ICHRA cannot also be offered a traditional group medical plan.

4. The ICHRA may be designed to reimburse any §213(d) qualifying medical expenses, including individual health coverage and Medicare premiums.

5. ICHRA coverage options & ERISA safe harbor.

6. ICHRA Network Access & Affordability.

7. Participants must be able to opt out of coverage and waive future reimbursement.

8. An annual notice must be provided to eligible individuals.

9. ICHRAs will likely require annual reporting.

10. Continuation Coverage – ICHRAs are group health plans subject to federal COBRA.

11. ERISA Documentation & Reporting – ICHRAs are group health plans subject to ERISA.

12. HSA-Eligibility.

13. Nondiscrimination Rules – ICHRAs are self-funded group health plans subject to §105(h) nondiscrimination rules.

14. ICHRAs are available to employers of all sizes.

15. ICHRA Sales.

16. ICHRA Education.

To complete this certification, you will need to submit documentation (e.g. screen shot from your system and/or a short explanation) to show how you are set up to handle a few of the key ICHRA requirements.