Healthcare cost strategy
Some organizations review an individual-coverage approach while evaluating how health-benefit funding is structured. Outcomes depend on plan design, the individual market, and each organization's circumstances.
ICHRA Solutions
A different way to provide health benefits.
Health benefits do not have to look the same for every workforce or population. An Individual Coverage Health Reimbursement Arrangement (ICHRA) can provide an employer-funded pathway to individual health coverage for eligible employees. Benefits Beyond Work helps connect that strategy to the individual — with personal insurance education, coverage guidance, and human support for employees and their households.
Why organizations look at ICHRA
A different coverage pathway for the workforce.
An ICHRA is not right for every organization or every population, and it is not a replacement for a group health plan that serves people well. It is another benefit strategy worth understanding. Whether an ICHRA fits depends on the workforce, plan design, applicable federal rules, the individual insurance market, carrier availability, and other factors.
Defined employer contributions
An ICHRA is funded through employer contributions defined in the arrangement, which some organizations evaluate when considering how contributions are set.
Employee choice
Eligible employees select individual health coverage available to them rather than choosing only from the plans in a group offering.
Geographically distributed populations
Workforces spread across many markets may have different provider networks and available plans in each location.
Employee classes
Federal rules allow an offer to be structured around certain permitted employee classes, subject to applicable requirements.
Part-time and seasonal populations
Some populations sit outside traditional group-plan eligibility, and an employer may evaluate whether an ICHRA is an appropriate way to support them.
Different workforce segments
One workforce may include segments with meaningfully different coverage needs and employment patterns.
Individual-market coverage
Where the individual market offers appropriate options, that coverage may be worth understanding alongside a group approach.
An additional pathway to evaluate
For appropriate populations, an ICHRA may be an alternative to a traditional group-plan approach — another strategy worth understanding, not a replacement for one that already works.
Employee classes
Offers can be structured around certain permitted classes.
Federal ICHRA rules allow an employer to structure an offer around certain permitted employee classes, subject to applicable requirements. Classes cannot be created arbitrarily, and the rules that govern them are detailed. Examples of classes that may be permitted include:
- Full-time employees
- Part-time employees
- Seasonal employees
- Salaried and non-salaried employees
- Employees in certain geographic rating areas or work locations
- Employees covered by a collective bargaining agreement
- Other classes permitted under applicable federal rules
This is a general educational summary and not a statement of the regulatory framework, legal advice, or tax advice. Whether a class may be used, and how an arrangement must be structured, is determined by applicable federal rules and by the employer together with its own benefits, administration, legal, and tax professionals.
From benefit strategy to individual experience
The difference isn't the arrangement. It's what happens next.
Once an ICHRA is in place, the employee has to navigate individual health insurance. That is where Benefits Beyond Work works.
Educate
Help employees understand what the change means and which decisions actually require their attention.
Connect
Provide an appropriate pathway into individual health coverage where the employee is eligible for the arrangement.
Guide
Help individuals and households understand the personal insurance options available to them.
Support
Provide access to a Financial Relationship Manager™ where human guidance is appropriate.
Continue
Maintain a personal-insurance relationship beyond the initial enrollment or employment transition.
An arrangement can be well designed and still leave the employee with questions only a person can answer.
Benefit Continuity Framework
One possible coverage pathway — not the only one.
Benefits Beyond Work helps organizations plan ahead, respond when benefits or eligibility change, and support what comes next. An ICHRA is one coverage pathway within that framework. Which pathways are actually available depends on the population, the plan, applicable rules, and each person's circumstances — they are not interchangeable.
- Existing group coverage, where it remains available and appropriate
- An ICHRA together with qualifying individual health coverage
- Individual health coverage outside an employer-funded arrangement
- COBRA or other continuation coverage, where applicable
- Medicare, where the person is eligible
- Other appropriate personal insurance solutions
Benefits Beyond Work does not administer the employer’s plan and does not determine plan eligibility or legal rights. Plan documents and applicable rules control.
From Work to Home
Start with what already exists.
An ICHRA may change how an employee obtains health insurance. It does not change the fact that the household may already have benefits and personal coverage worth understanding before assuming something new is required.
Understand
Review what the household already has through work — healthcare, protection, retirement, and voluntary benefits.
Preserve / Optimize
Identify what may continue, remain useful, or offer portability or conversion where plan provisions allow.
Identify
Look across the household for needs that are changing, ending, unavailable, or no longer appropriate.
Supplement
Consider personal insurance only where an appropriate need remains.
Household differentiator
The employee isn't the only person affected.
A health-benefit decision at work can reach further than the employee. Where appropriate, we help the conversation extend to the household.
One coverage change. Different household considerations.
Eligibility
A spouse, partner, or dependent may have different eligibility for coverage or for the arrangement itself
Existing coverage
Someone in the household may already have coverage through another employer or source
Employer options
Another employer's offer may change what makes sense for the household
Medicare status
A household member who is Medicare eligible has a separate set of considerations
Healthcare needs
Providers, prescriptions, and expected care can differ from person to person
Other insurance needs
Protection, property, retirement, and legacy needs may also deserve review
What is relevant depends on age, employment, existing coverage, eligibility, and individual circumstances.
Financial Relationship Manager
More choice can also mean more questions.
Individual insurance can create more choice than a group offering. A Financial Relationship Manager™ provides an ongoing human relationship for the individual or household as appropriate personal-insurance needs are identified and addressed.
A Financial Relationship Manager is a personal-insurance point of contact. The FRM does not administer the employer’s ICHRA, approve reimbursements, or determine plan eligibility, and does not provide legal or tax advice.
Employer experience
How this tends to come together.
Each organization's process differs. Benefits Beyond Work participates in the personal-insurance, education, and human-guidance portion of it.
Identify the population
Determine where an alternative coverage pathway may be worth evaluating.
Define the strategy
The organization and its benefits, ICHRA, and other appropriate professionals determine whether and how an ICHRA may fit.
Communicate
Employees receive appropriate education about what the coverage experience will look like.
Connect
Eligible individuals are connected to the individual-insurance experience.
Support
Benefits Beyond Work provides personal-insurance education and human guidance within its role.
Continue
The employee or household has a resource beyond the initial enrollment.
Role clarity
What we do — and what we don't.
Benefits Beyond Work supports the individual side
Personal-insurance education, individual health coverage guidance where we are appropriately able to assist, household perspective, and access to a Financial Relationship Manager™ for ongoing human support.
Other roles belong with other parties
ICHRA plan design, plan documents, administration, reimbursement and substantiation, compliance, and legal and tax determinations may be performed by the employer and its appropriate benefits, administration, ICHRA platform, or professional partners.
Benefits Beyond Work is an independent personal insurance agency and is not affiliated with any government agency. Nothing here is legal or tax advice. Coverage, carrier, and producer availability vary by state, and individual circumstances, plan design, and applicable federal rules determine what is actually available.
For federal information about individual health coverage and Health Reimbursement Arrangements, see HealthCare.gov.
Is an individual-coverage pathway worth evaluating for part of your workforce?
Start with the population and what you are trying to support. We can talk through the personal-insurance and employee-experience side of it.