Topic Progress:

Compliance and administration issues


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.

Annual Substantiation

Prior to enrollment, the plan must verify that employees, spouses, and dependents enrolling in the ICHRA are, or will be, enrolled in individual health coverage or Medicare during the plan year.

Ongoing Substantiation

Prior to any reimbursement from the ICHRA, the individual requesting reimbursement must provide substantiation that the individual was enrolled in individual health insurance coverage or Medicare for the month during which the expense(s) were incurred.

Ongoing substantiation of continued enrollment in individual health coverage or Medicare can be satisfied by collecting a written attestation from the participant on the same form used for requesting reimbursement.

Substantiation of medical expense reimbursements other than premiums requires appropriate third-party verification similar to requirements applicable to any HRA or health FSA.