Individual Coverage Health Reimbursement Arrangements (ICHRA): What you should know
What is an ICHRA? It is a reimbursement arrangement provided by employers. It works differently than traditional group insurance coverage offered by employers to employees. ICHRA funds can be used by an employee to choose and buy an individual insurance plan for themselves (and, in some cases, their dependents), and receive reimbursement from their employer for all or some of their premium (the monthly amount paid for a health plan). An ICHRA may be used to reimburse other IRS-qualified medical expense such as prescription drug.
Frequently asked questions about ICHRA coverage
How do I know if I have coverage through an ICHRA?
Your employer will notify you if you are eligible for this type of coverage.
If your employer offers you an ICHRA and you selected a Capital Blue Cross individual plan, your monthly billing statements will indicate that you are part of an ICHRA. If you have questions about your Capital plan, call the number on the back of your ID card (TTY: 711). If you have any questions about your ICHRA, please contact your employer or its designated ICHRA administrator.
What are the advantages of choosing a Capital Blue Cross plan when you have an ICHRA?
Capital Blue Cross health plans give you access to high-quality healthcare that’s close to home, and feature:
- Lower-cost plan options.
- Access to an extensive network of providers and hospitals.
- $0 preventive care.
- A chance to earn up to $100 in rewards for hitting your wellness goals.
- Coverage of mental health and substance use disorder services.
- VirtualCare—get care from home.
- Enhanced Rx program with no cost share on popular generic drugs.1
- Insulin saver program with reduced cost on certain preferred insulins.1
- Potential savings on many common generic drugs through Mark Cuban Cost Plus Drug Company2.
- Four free counseling sessions via our Member Assistance Program.
1Not applicable for qualified high-deductible health plans (QHDHPs).
2Mark Cuban Cost Plus Drug Company, PBC is contracted through Prime Therapeutics LLC to provide mail pharmacy services to members of Capital Blue Cross. On behalf of Capital Blue Cross, Prime Therapeutics LLC assists in the administration of our prescription drug program. Prime Therapeutics LLC is an independent pharmacy benefit manager.
My employer offered me an opportunity to select a health plan through its ICHRA administrator, and I’m interested in choosing a Capital Blue Cross plan. How do I make my selection?
Individuals who live in our 21-county service area in Pennsylvania will have an opportunity to choose a Capital Blue Cross plan.
Capital offers medical plans in these 21 Pennsylvania counties: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Synder, Union, and York.
Your employer will provide you with directions on how to select a plan from various carriers during open enrollment. If you are newly eligible for an ICHRA, you may be eligible for a Special Enrollment Period (SEP). Your employer may direct you to a specific website with plan options in your region. Contact your employer directly with any questions about the enrollment process.
I am leaving my job and I am no longer eligible for an ICHRA. What happens to my health coverage?
Unless you notify us otherwise, your coverage will remain active, so long as you continue to make premium payments. Check out payment options.
If you are unable to afford the monthly premium for your health plan, you may be eligible for financial help through Pennie®, Pennsylvania’s health insurance marketplace. Capital offers a variety of individual and family plans on Pennie in our 21-county service area. Go to Pennie’s website to learn more about your potential eligibility for a marketplace plan and financial assistance. If you choose an alternate plan using Pennie, please be sure to contact us to cancel your current plan.
Capital Blue Cross and its affiliates do not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. Groups and Members should consult their own tax, legal and accounting advisors concerning the application of tax laws to their particular situation.