Introduction to ICHRA

Sample Employer is offering an innovative approach to employee benefits for 2023. The ndividuial coverage health reimbursement arrangement, also known as ICHRA, is designed to allow you to choose the carrier and medical benefit options that suit you and your family best. The ICHRA allows you to choose the insurance carrier you prefer, the plan design you like best and the deductible and copay options that best fit your budget.


The ICHRA offered by Sample Employer is designed as an affordable offer of coverage for all our employees and therefore fully complies with federal coverage mandates. A new summary plan document is available at this link.



Open Enrollment is from November 15th to December 15th. New benefit elections take effect on January 1, 2022

Using Your ICHRA

Sample employer is offering each employee (up to) $x.00 per month pre-tax? through an individual coverage health reimbursement account. (ICHRA) You may use the funds from the ICHRA to pay for medical coverage offered through the insurance carrier of your choice. (If the cost of your coverage is less than $x.00, you may use the remaining funds to cover additional medical expenses like copays, deductibles or even the cost of over-the-counter medications. A list of approved HRA expenses can be found at this link.)


If you are age 65 or older, you may use these employer funds to pay for your costs for Medicare Part B and a Medicare supplement or Medicare Advantage plan. NFP Medicare Advisors will assist you in finding the appropriate Medicare plan based on the doctors and hospitals you use most, your lifestyle and your budget. Please use the calendly link to schedule a time to speak with our Medicare Advisors at your earliest convenience.


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Enrolling in an Individual Medical Plan

In Western Pennsylvania, both UPMC Health Plan and Highmark Blue Cross Blue Shield offer medical plan options for individuals and families. When shopping for plans, it is important to consider several factors:


  • Are my doctors and/or preferred hospitals in network? Both Highmark and UPMC Health Plan offer plans with varying levels of access to providers. Typically, the smaller the provider network, the lower the premium. UPMC's Partner network is the smallest network of providers and carries the lowest cost. UPMC's Premium Network represents the largest network of providers offered by UPMC. Highmark's My Blue Access represent Highmark's largest network of providers while Highmark's Together Blue products offer the smallest network Highmark offers. Not all plan options are available in all counties, so it is important to look for options specifically available in your county.
  • Do I need coverage from out of network doctors and hospitals? Both carriers also offer plans that provide coverage when seeking care out of network (PPO) but those always carry a higher premium cost than a plan that only covers care in network (EPO).
  • How much do I typically use my coverage? If you rarely use your insurance coverage and purchase it to cover you "just in case", you may want to consider a lower cost option with higher deductibles and out of pocket maximums. If you are someone who regularly visits the doctor or has chronic or recurring medical issues, you may prefer to select a plan with a higher premium, but lower copays and deductible associated with seeking care.


IMPORTANT: Because you are being offered affordable coverage as determined by the Department of Labor, you are not eligible to receive a government subsidy on Pennie. If you apply for and receive a subsidy on Pennie, you may be required to pay this back during tax time.


Neither Sample Employer or NFP endorse any carrier or plan options but we have listed below the options that most closely align with your current group plan.


LIST 1 or 2 UPMC and 1 or 2 HIghmark options. Label them with their unique name and include a link to their SBC


NFP Advisors are available to discuss coverage options with you. Please use this calendly link to schedule time with an Individual Insurance Advisor fi you are unsure which plan would be best for you.


OR


Use the GoWell tool to shop and enroll. (add link)

Group Vision, Dental or Ancillary Benefits

Action Required

Describe other group benefit options here.


HOW will they enroll in these other benefits?

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