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Agent and Broker Frequently Asked Questions Database September 16, 2020

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Agent and Broker Frequently Asked Questions Database September 16, 2020 CCIIO Division of Small Business and Agent/Broker Innovation Agent and Broker Frequently Asked Questions Database September 16, 2020 Commented [OGC-bp1]: Legal (Global). If CCIIO hasn’t Agent and Broker Frequently Asked Questions Database already done so, Labor, Treasury and IRS colleagues should Health Reimbursement Arrangement FAQs be provided an opportunity to review these FAQs. Commented [SE2]: Confirming that Treasury and IRS have already reviewed and approved these FAQs. What is an Individual Coverage Health Reimbursement Arrangement? Commented [OGC-bp3]: Legal (Global). Edits are legal in An individual coverage Health Reimbursement Arrangement (HRA) is an alternative to traditional group nature, unless noted otherwise. health plan coverage that’s used to reimburse medical care expenses, like monthly premiums and out-of- pocket costs such as copayments and deductibles. Individual coverage HRAs can be offered by employers In addition, CMSD did not confirm the information in the hyperlinked material as part our review, but are happy to do of any size, as long as they have one employee who isn’t a self-employed owner or the spouse of a self- so upon request. employed owner. There are no annual minimum or maximum contribution requirements for an individual Commented [SE4]: Sources: coverage HRA, and this type of HRA can permit rollover of unused amounts from year to year. However, •https://www.healthcare.gov/ichra/ to meet the employer shared responsibility requirement, an applicable large employer’s contribution •https://www.healthcare.gov/small-businesses/learn- more/individual-coverage-hra/ level must ensure the employer’s individual coverage HRA offer is affordable to full-time employees. Commented [PN5]: Recommend adding a sentence here Learn more about the ESRP. to highlight that , while there are no minimums, a large employer subject to the mandate must meet a minimum to In order to be covered by and receive reimbursements for medical care expenses from the individual satisfy the mandate. coverage HRA, an individual coverage HRA requires employees and any covered spouse and dependents Commented [SE6]: Confirming this language and a link to the other FAQ have been added. to be enrolled in individual health insurance coverage; or Medicare Parts A and B, or Part C. This can include reimbursement for premiums for individual health insurance coverage offered on or off a Commented [PN7]: I was thinking of something simpler Marketplace. However, it does not include reimbursement for short-term, limited duration insurance or Commented [SE8]: Accepted coverage consisting solely of dental, vision, or other excepted benefits. Commented [OGC-bp9]: Non-Legal. Commented [SE10]: Accepted Employers can choose to offer an individual coverage HRA to all employees, or they can choose to offer it Commented [SE11]: Source: only to certain types of employees. These types — or classes — of employees must follow the https://www.cms.gov/CCIIO/Programs-and- classifications specified in the regulations (e.g., full-time or part-time). However, employers cannot offer Initiatives/Health-Insurance-Market- Reforms/Downloads/ICHRA-Pre-Open-Enrollment-Period- any employee a choice between a traditional group health plan and an individual coverage HRA. Find a Training.pdf (slide 6) full list of available classes here (PDF). Commented [PN12]: Seems repetitive. The previous paragraph already mentions an HRA can cover premiums. Learn more about how you can help clients who have an individual coverage HRA offer. Also, the sentence was quite long. Commented [SE13]: Accepted If you need additional assistance, contact the Agent/Broker Email Help Desk at FFMProducer- [email protected]. Helpful resources: • HealthCare.gov – What's an individual coverage HRA? • HealthCare.gov – Individual coverage Health Reimbursement Arrangements • Individual Coverage HRAs and the Marketplace (PDF) • New Health Coverage Options for Employers and Employees (PDF) 1 CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. CCIIO Division of Small Business and Agent/Broker Innovation Agent and Broker Frequently Asked Questions Database September 16, 2020 • Health Reimbursement Arrangements and Other Account-Based Group Health Plans Final Rule (PDF) 2 CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. CCIIO Division of Small Business and Agent/Broker Innovation Agent and Broker Frequently Asked Questions Database September 16, 2020 What is a Qualified Small Employer Health Reimbursement Arrangement? Small employers – generally those with fewer than 50 employees – that doesn’t offer group health Commented [SE14]: Sources: coverage to their employees can help employees pay for medical expenses through a Qualified Small •https://www.healthcare.gov/small-businesses/learn- more/qsehra/ Employer Health Reimbursement Arrangement (QSEHRA). Employees can use a QSEHRA to help pay for •https://www.healthcare.gov/qsehra/ their household’s health care costs for qualifying health coverage. Small employers can decide what to contribute to their employees’ and any covered spouse and dependents’ health care costs, up to the annual maximum; the annual maximum is adjusted year to year. This type of HRA can permit rollover of Commented [OGC-bp15]: Non-Legal. unused amounts from year to year. Commented [SE16]: Accepted A QSEHRA allows small employers to provide non-taxed reimbursement of certain medical care expenses, like health insurance premiums and coinsurance, to employees who maintain minimum essential coverage, like a plan from the Individual Marketplace. To get non-taxed reimbursements from a QSEHRA, an employee (and any covered spouse and dependents) must be enrolled in minimum essential coverage. Commented [SE17]: Source: QSEHRAs allow small employers to help their employees purchase additional plan choices without the https://www.cms.gov/CCIIO/Programs-and- Initiatives/Health-Insurance-Market- employer having to manage group health plan coverage. Reforms/Downloads/ICHRA-Pre-Open-Enrollment-Period- Training.pdf (slide 7) To provide a QSEHRA to its employees, a small employer generally must: Commented [SE18]: Source: https://www.healthcare.gov/small-businesses/learn- • Have fewer than 50 full-time employees. more/qsehra/ • Provide the arrangement on the same terms to all eligible employees (reimbursement amounts may only vary based on age and the number of individuals covered). • Not offer a group health plan, such as Small Business Health Options Program (SHOP) coverage, or a flexible spending account. If you need additional assistance, contact the Agent/Broker Email Help Desk at FFMProducer- [email protected]. Helpful resources: • HealthCare.gov – What's a QSEHRA? • HealthCare.gov – Health Reimbursement Arrangements (HRAs) for small employers • IRS Notice 2017-67 – Qualified Small Employer Health Arrangements 3 CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. CCIIO Division of Small Business and Agent/Broker Innovation Agent and Broker Frequently Asked Questions Database September 16, 2020 What is an Excepted Benefit Health Reimbursement Arrangement? Commented [SE19]: Sources: An excepted benefit Health Reimbursement Arrangement (HRA) allows employers to finance additional https://www.healthcare.gov/small-businesses/learn- more/hra-guide/ (“What is an excepted benefit HRA?”) medical care, like vision or dental coverage, coinsurance and copayments for individual health insurance coverage, short-term limited-duration insurance, or other health care costs not covered by their primary https://www.hhs.gov/sites/default/files/health- group plan. Excepted benefit HRAs cannot be used to reimburse individual health insurance coverage reimbursement-arrangements.pdf (Q11) premiums, group health plan premiums (other than COBRA or other group continuation coverage), or Commented [OGC-bp20]: Legal. To use the term of art. Medicare premiums. However, an excepted benefit HRA can be used to reimburse premiums for Commented [SE21]: Accepted individual health insurance coverage or group health plan coverage that consists solely of excepted benefits. This type of HRA, like the individual coverage HRA, allows rollover of unused amounts from year Commented [OGC-bp22]: Legal. For precision. See, e.g., to year. the June 2019 HRA Final Rule, 84 FR at 28937. Commented [SE23]: Accepted The annual contribution for an excepted benefit HRA must be limited to $1,800 per year (adjusted yearly Commented [PN24]: Recommend adding the rollover for inflation).
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