In order to participate in your ICHRA benefit, your insurance must meet specific requirements in order to be reimbursed and for it and for any other expenses (if applicable) to be eligible for reimbursement. This article shares additional details about those requirements and the type of coverage you'll need to have.
What is Individual Coverage?
Individual coverage is an individual health insurance policy, including on-exchange or off-exchange coverage, Medicare Parts A and B, or Medicare Part C that meets minimum essential coverage requirements (MEC). You may be the primary policyholder or your spouse may be the primary policyholder. This article will help you understand what types of coverage are considered an individual plan.
Why is it important?
In order to participate in the Individual Coverage Health Reimbursement Arrangement (ICHRA), you must have an individual health plan that meets minimum essential coverage requirements (MEC). MEC refers to a medical insurance policy that meets the standards established by the Affordable Care Act.
In short, to meet the standards, a policy has to cover at least 60 percent of covered costs and cover the 10 essential health benefits.
If you do not have individual coverage, you are not eligible for this benefit and cannot be reimbursed for your health care costs.
Is my policy an individual health insurance policy?
|
Policy Type |
Would this coverage enable me to participate? |
|
|
Individual & Family |
Marketplace Insurance |
YES |
|
Major Medical Insurance Directly Through Carrier |
YES | |
|
Medicare Insurance |
YES | |
|
Group Insurance |
Spouse's Employer-Provided Insurance |
NO |
|
Parent's Company Provided Insurance |
NO | |
|
Retiree Benefit Insurance |
NO | |
|
COBRA |
NO | |
|
Other Insurance |
Medicaid Insurance |
NO |
|
CHIP Insurance |
NO | |
|
TRICARE Insurance |
NO | |
|
Vision Insurance |
NO | |
|
Dental Insurance |
NO |
|
|
Short-term Medical Insurance |
NO |
|
|
Long-term Care Insurance |
NO | |
|
Dependent on a Parent's Policy |
NO | |
|
Alternative coverage |
Lump-Sum Policies E.G. Accidental, Critical Illness, or Indemnity Insurance |
NO |
|
Medi-Share |
NO | |
|
Indian Health Services |
NO |
What if I have more than one policy?
So long as you have an individual policy, listed as eligible above, you can choose to opt-in and participate in the ICHRA benefit. Once opted in, you decide how you'd like to use your allowance! If you do have a second policy in addition to what's listed above, for example TRICARE, you can use your allowance to be reimbursed for both policies.
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