Page 42 - Delaware Medical Journal - September/October 2020

MSDIS CORNER
as well as individual market premiums, it would not be compatible with an HSA.
Under some circumstances, ICHRAs can be used to reimburse premiums for Medicare and Medicare supplemental (“Medigap”) health insurance.
An employer subject to the Medicare Secondary Payer rules may offer
an ICHRA to a class of employees that includes some Medicare enrollees. The ICHRA may not limit reimbursement of medical expenses to only those not reimbursed by Medicare. However, the ICHRA
EXCEPTED BENEFIT HRAS
There is another HRA that became available January 1, 2020, called an excepted benefit HRA (EBHRA). As an excepted benefit, the EBHRA can reimburse general medical expenses without integration, so long as it satisfies the applicable guidelines. This HRA would require that your employees be offered group health plan coverage from the same employer, but the employee does not have to enroll
in that coverage. The employee cannot also be offered an ICHRA.
or vision). Thus, integrated managed care (IMC) premiums, non-COBRA group coverage, and costs of Medicare Parts A, B, C, or D, would not be eligible expenses. Short-term limited- duration insurance (STLDI) coverage could, however, be reimbursed
under an EBHRA. Benefits offered must be the same for all “similarly situated” individuals (as defined by
the Health Insurance Portability and Accountability Act [HIPAA] wellness nondiscrimination rules). “Similarly situated” employees are employees within the same employment-based classification that is consistent with
the employer’s usual practice, such as full-time, part-time, hourly, salaried, or worksite location.
These kinds of benefit arrangements offer some exciting and interesting options that your practice should be considering when preparing for your upcoming renewal. They are also
a unique way to offer some type of benefit to your employees without impacting your budget.
Give the team at MSDIS a call to discuss these options. Sharon Ruth, Senior Client Advocate, is ready to assist you.
CONTRIBUTING AUTHOR
■ SHARON RUTH is a Senior Client Advocate who wastes no time when it comes to advocating for her clients and prospects. She coordinates all lines of Property and Casualty coverage for the Medical Society of Delaware Insurance Services, Inc. (MSDIS), specializing in Medical Malpractice. She will be happy to assist you with your insurance questions or concerns. Contact Sharon at 302-397-0173 or sharon.ruth@usi.com.
ALL ICHRA REIMBURSEMENTS ARE FREE OF BOTH PAYROLL AND INCOME TAX
may be limited to reimbursement of Medicare and Medigap premiums and general medical expenses. Employers who are not subject to the Medicare Secondary Payer rules may continue
to integrate HRAs with Medicare in The Department of Health and Human Services is expected to issue additional guidance clarifying various issues.
Employees who are eligible to participate in the ICHRA must be given the opportunity each year to waive out of the plan. Employers must provide written notice at least 90 days prior to the start of the plan year and provide certain content that summarizes the provisions of the plan. If the HRA is established less than 120 days prior
to the beginning of the plan year, the notice may be provided no later than the date on which the plan will take effect for the participant.
There is a maximum annual contribution to the EBHRA of $1,800, adjusted for inflation. This does not include carryover amounts, which may be unlimited. If the employer offers any other HRA to the employee for the same time period (other than one that reimburses only excepted benefits), the aggregate annual contribution for all such HRAs cannot exceed $1,800. The aggregate $1,800 contribution maximum does not apply to flexible spending accounts (FSAs) or HRAs that reimburse only excepted benefits, such as dental or vision benefits.
The EBHRA may reimburse most Code Section 213(d) medical care expenses incurred by participants; however,
it may not reimburse any insurance premiums except COBRA or other continuation coverage premiums,
and premiums for plans that only provide excepted benefits (e.g. dental
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Del Med J | September/October 2020 | Vol. 92 | No. 5