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November 4, 2024 14 mins

ICHRAs (individual coverage health reimbursement arrangements) are a relatively new type of health plan that allows employers to offer their employees a tax-free allowance to purchase benefits. While ICHRAs are growing in popularity, many businesses are hazy on the details. Unfortunately, myths and misperceptions about ICHRA could lead a business to dismiss a benefits option that may be right for them.  Listen as we debunk:

  • [2:46] Myth #1: The marketplace has challenges — ICHRA can’t be good insurance.
  • [4:30] Myth #2: A business with no HR department doesn’t have access to enough resources to set up an ICHRA.
  • [5:48] Myth #3: It’d be easy for most businesses to administer an ICHRA on their own.
  • [7:01] Myth #4: Old HRA models didn’t fit the business before; new ones are probably no different.
  • [8:17] Myth #5: Employees will be overwhelmed by the choices in the insurance marketplace.
  • [10:25] Myth #6: Employees won’t spend their benefits allowance on health-related expenses.
  • [12:01] Myth #7: Switching to an ICHRA will be a pain.

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Episode Transcript

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Jim (00:00):
In a previous podcast, we began exploring health
reimbursement arrangements.
HRAs allow employers to offertheir employees a tax free
allowance to purchase benefits.
A relatively new type of HRA isthe Individual Coverage Health
Reimbursement Arrangement, or ICHRA.
While ICHRAs are growing in popularity,many businesses are hazy on the details.

(00:21):
Unfortunately, myths and misunderstandingsabout ICHRA could lead a business
to dismiss a benefits option
that may be right for them.
Welcome to HRpreneur.
I'm Jim Duffy.
From main street to your street, theHRpreneur podcast is centered around
helping small businesses like yoursgain the knowledge you need from
HR, payroll, and hiring to time,taxes, benefits, and insurance.

(00:44):
Today, we're joined by two guests fromTake Command Health, a Dallas, Texas
based company that specializes in HRAs.
Andy Lange is Vice President of PeopleOperations and Kyle Estep is Vice
President of Policy and Partnerships.
Andy and Kyle, welcome to HRpreneur.
It's great to have youback on the program again.
Thanks, Jim.
Uh, happy to be back andtalking health insurance.

(01:06):
Really appreciate you having us, Jim.
All right, gentlemen.
So let's get started by talkingabout some key benefits of ICHRA.
Kyle, would you mind takingus into the start here?

Kyle (01:16):
Sure, Jim.
And again, thank you for havingus on the show and the opportunity
to clarify what ICHRA is.
So to start at a high level,it's a really simple concept
hidden by this gnarly acronym.
With an ICHRA, an employer is setting anallowance and giving it to the employees
so they can purchase health insurance.
And there are two majorbenefits with this model.

(01:37):
For the employer, It's cost certainty.
Instead of being nervous aboutwhat is that, you know, health
insurance company going to chargeme with that group plan premium.
I get to set a budget and givethose employees an allowance.
And I know what my costs are going tolook like going forward for the employees.
They get the power of choice.

(01:57):
Those employees get to use that allowanceand purchase the plan that best meets
the needs of them and their families,

Jim (02:03):
Kyle.
Thank you.
These are definitely solid reasons tolook to ICHRA, whether a business already
offers group health or is looking atit as an alternative, but we've heard
some concerns from potential customers.
And Andy, would you mind tellingus a little bit more about that?

Andy (02:18):
Yeah, I mean, that totally makes sense. 51-
Uh, HRAs
are still very new to alot of businesses and 56,
HR Professionals. 58,
I was one of them, youknow, as the head of HR 60-
For now, a company thathas been administering HRAs
for years and over 100 employees,
I can speak from experience.
You know, ICHRA works and hopefullyas we go on today, we can get into

(02:40):
some of the Other advantages ofoffering an HRA and quell some of
those concerns that you mentioned.

Jim (02:46):
So listeners may recall that with ICHRA, employees are responsible
for purchasing their own insurance.
Most buy on the individualinsurance market, which people
may think of as Obamacare, butsome purchase through Medicare.
So now, we sometimes hear frombusiness owners who claim the
marketplace has too many challenges,so ICHRA can't be a good option.

(03:08):
Can you tell me more?
Kyle.

Kyle (03:10):
Yeah, so it's definitely true that historically there were stark differences
between the individual market and thegroup health market, namely that, you
know, employees or individuals couldbe discriminated against if they went
to go purchase insurance on their own.
Oh, sorry, you got cancer.
You can't get coverage.
Well, all of that changed thanksto the Affordable Care Act.

(03:31):
Now those employees, when theygo shop for their own individual
plan, it doesn't matter if they'resick, healthy, or otherwise.
They're going to pay a stable premium.
And there's going to be coveragefor those pre existing conditions.
So the plans themselves look andfeel a lot like a group plan.
Beyond that, if we look at the more recenthistory, it was also true that maybe five

(03:52):
or ten years ago, you could get a smallbusiness group health insurance plan for
less money than you could get an insuranceplan if you were buying it on your own.
Well, that's changed quite a bit.
And in fact, as we look at differentmarkets throughout the country,
about half of them, according tosome data from a vendor named Ideon,
show that the individual plans arebasically lower than the actual small

(04:14):
group equivalent insurance plan.
So there is some regional nuancehere and you'll definitely want to
take a look at your local market,but it's safe to say that no matter
where you are in the country, you'regoing to have some really good options
when buying a plan for your family.

Jim (04:28):
Thank you, Kyle.
Uh, Andy, so the marketplace hasimproved, but some small businesses
don't have an HR department, so manyowners don't feel like they have
access to resources to set up an ICHRA.
Are the plans difficult to implement?

Andy (04:43):
You know, that's a great question, especially for the small businesses.
And the reality is, by offeringan ICHRA, it really is like you're
outsourcing this function of kindof your benefits, uh, strategy.
An ICHRA vendor will be doing kind of allthe heavy lifting reporting, compliance,
communication as a reference point.
And I have, remember over ahundred employees, it's, it's

(05:05):
a lot more complicated, um,than for a small business.
I still only spend maybe an houra month managing their benefits
offering, which is just huge for me.
And if I may, while we're kind oftalking to the HR guy, uh, another
potential benefit, ICHRA can be a hugeasset for a business that wants to
step up its recruitment and retention.

(05:26):
Huge, especially for small businesses.
For some businesses, an ICHRAmeans that they can finally offer
insurance for the first time.
For others, it helps them offer insuranceto more types of employees, and it can
get nuanced, and we can get into that.
But the truth is, health insuranceis one of the workers most sought
after benefits, and ICHRA really isa great way to provide that to small,
all the way up to large businesses.

Jim (05:47):
Thanks, Andy.
I heard you focus a little bit thereon the small lean businesses in
particular might find ICHRA of value,but what if a business does have an
administrative staff with employeesresponsible for picking their own plans?
An owner might feel it'd be easier justto administer the ICHRA themselves.
Kyle, can you shed some light on that?

Kyle (06:07):
Well, Jim, I'm our head of compliance here at take command.
And when I hear this,I cringe a little bit.
Trust us.
This is not a do it yourself scenario.
Managing these HRA programs, you know,really, without a proper administrator
or platform in place is a lot of workwith potentially expensive pitfalls.
So just one example, collecting themedical receipts to verify that the

(06:30):
employees, you know, medical expensesor premiums are actually qualified.
Um, if they're not really careful, uh, youcould violate privacy, HIPAA rules, and
the penalties here could be very large,so you could even envision a scenario
where the ICHRA was ruled invalid, andall of those taxes were owed because, in
fact, it wasn't a compliant program, so.

(06:52):
You know, we at Take Command and othersstep in to really give that peace of
mind to an employer to make sure thatthe program's being run compliantly.

Jim (07:01):
Okay, as a quick follow up to that, so let's say the last
time a business looked into HRAs,the model was too restrictive.
So Kyle, how is ICHRA different fromother HRAs that they've seen in the past?

Kyle (07:13):
So HRAs have actually been around for a long time, but traditionally
they could only be used to offermedical expense reimbursement.
You could not give money to anemployee to help them pay for
the actual insurance program, orwhat we call the premium, right?
What they spend on the insurance.
But what happened was, In 2017, wegot this new model called a QSEHRA,

(07:36):
a qualified small employer, HRA.
Don't worry, there's not gonna bea quiz at the end of this podcast,
But the reason I bring it up is that wasintroduced in 2017 for small businesses
and it had some restrictions on it.
It was.
Only available to really small businessesand there were limits on how much
you could provide to an employee.
And you couldn't, you know, vary whatan employee in a high cost market
like California might get comparedto a lower cost market in New Mexico.

(08:01):
Well, now you have ICHRA and it's gotsome of these flexibilities built in.
So I'd encourage anyone that might havetaken a look at a QSEHRA or traditional
medical expense reimbursement programin the past and been disappointed.
Give it a fresh look now with ICHRAand see if it'll meet your needs.

Jim (08:17):
So, businesses with traditional group health, uh, make it
manageable for themselves and theiremployees by limiting plan choices.
What would you say to employeeswho think picking a plan for
their ICHRA will be overwhelming?
Andy, would you take that one?

Andy (08:33):
Uh, that's a great question.
And when you have dozens or evenhundreds of choices to choose from, it
can be absolutely overwhelming choosingthe right ICHRA vendor and platform.
Employees can filter plans by HSAeligibility, what works for their
doctors or prescriptions and what worksfor their budget to take it further.
With the right ICHRA administrationand I'll, I'll tout our own company.

(08:57):
Employees can schedule calls withlicensed insurance agents that will
walk them through signing up for a plan.
The reality is that most employees
aren't used to shopping for healthinsurance, but the business should make
sure to work with a vendor like ours whocan provide the support that they need.
I can't tell you how important it is.
Even internally, we have employeesthat are joining, Take Command.

(09:19):
That should know a lot about, uh,ICHRA and they still need help.
It is such a big deal to have somebodythat you can call and help you.

Jim (09:26):
So Andy, just a little follow up.
Is there anything about thetechnology platform that you'd
want to highlight at all?

Andy (09:32):
Uh, it really is pretty easy to use.
The user interface is straightforward.
As an administrator, I have all theinformation I need at my fingertips
to administer the plan, to answerUh, questions for employee shopping.
It's pretty straightforward.
Most employees are really, youknow, they don't engage that often.
We kind of wish they would becauseit's such a pretty platform, but
they don't engage that often.

(09:53):
They really just want to shop and it'sit's a really kind of intuitive platform.
The biggest thing is to pick up aphone and actually talk to somebody.
Yes, we have the technology, but this ispeople's insurance and their healthcare,
and they, they're going to want totalk to somebody that can help them.
And, and that's where I think we'retaking command is, is, is really

(10:13):
well positioned to help people.
And that's really why we do this.
We're, we want people to, Ihate to be cliche, take command
of their health insurance.

Jim (10:22):
Got it.
No, I appreciate that follow up.
Really do.
Thank you for that.
Uh, Kyle, here's a question for you.
Some employers aren't convinced theiremployees will spend their allowance
on insurance and medical expenses.
Uh, they might book a cruise insteador, or just put it in their pocket.
Can you tell us a littlebit more about this one?

Kyle (10:40):
Oh man.
Okay.
We hear this quite a bit.
It sounds like it's a cruise thistime, Jim, but I've heard all sorts
of crazy concerns from employers.
Um, let's be clear federal regulations
say that this tax free money can onlybe provided to the employee if we can
substantiate that that money is infact reimbursing the employee for an

(11:02):
insurance premium or medical expense.
This is again why an employer is going towant to work with the right ICHRA software
that has the appropriate compliancemeasures in place to ensure that the, for
example, medical expenses are being met.
Reimbursed and qualify.
Uh, so there's the whole IRS list thathas to be consumed into the technology

(11:24):
and or you want a compliance team behindthe technology double checking around.
Is this in fact aqualified medical expense?
And just as important when they'reactually enrolling in insurance,
making sure that the insuranceplan they're choosing works 235,
well with the ICHRA program, i.e.
it's considered qualifying coverage.

(11:46):
So you'll want to have a good, wellgroomed shopping experience that only
has those really high quality healthinsurance plans available to the employee.
Again, this is where working withthe right ICHRA vendor partner is
important if you're an employer.

Jim (11:59):
Thank you, Kyle.
So, okay, we've heard some compellingdetails about ICHRAs, but what do you say
to a business owner who thinks switchingor adding plans will just be a pain?
So, Andy, would you mindtaking us home here?

Andy (12:12):
Well, I mean, I think there's two parts to this.
Change management, generallyspeaking, is very, very hard.
It just is.
In this case, you are are changing whatyour employees are going to expect from
the health benefit, but you're alsochanging how you're implementing it.
I think as an HR professional,it's important for you to care

(12:33):
about your team and how they'regoing to use their benefits when
it comes to how it's implemented.
It's important to have a partnerthat helps you through it.
And that's exactly what wedo, um, through onboarding.
We get you, we get you set up.
We have continued support.
I mentioned the shopping, you know,we take command has an industry
best renewal rate of 90%, uh, whichreally means our clients so far.

(12:56):
They're not looking back, you know,and our agency and broker partners keep
sending interested business our way.
So change is hard.
And I think it's important to be therefor your team and help them understand
their benefit, and we can do that.
But the most complicated part, which isthe technology and the compliance that
Kyle spoke to earlier, we can handle that.

Jim (13:17):
Well, that brings us to the end of this episode.
Again, Andy and Kyle, thank you forjoining us once again on HRpreneur.

Andy (13:24):
Thanks, Jim.
Always a pleasure.
Jim, anytime.
This is a lot of fun.
Kyle, also, great being with you.

Jim (13:31):
We definitely appreciate your sharing your expertise with us
today and helping us dispel someof the common myths about ICHRAs.
Presented by ADP, HRpreneur focuseson the entrepreneurs and business
drivers who are shaping the growthof their companies and positively
impacting the lives of their employees.
With each episode, We'llbring the experts to you.
We'll answer your questions andhelp you think beyond today so you

(13:54):
can discover more success tomorrow.
As always, thanks for listening to HRpreneur.
Be well, and we hopeyou'll join us again soon.
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