Looser Restrictions on HRAs on the Horizon

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Looser Restrictions on HRAs on the Horizon

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  • Written by Managed Healthcare Executive

By Karen Appold, Managed Healthcare Executive

The U.S. Departments of the Treasury, Health and Human Services, and Labor issued a proposed regulation that expands the usability of health reimbursement arrangements (HRAs) in late October. If adopted as written, the new rules would apply for most health plans beginning January 1, 2020.

Here are four things healthcare executives should know about the proposal.

  • If the regulation is passed, HRAs could be used to cover new types of expenses. Specifically, the rule creates two new types of HRAs—Individual Coverage HRAs (ICHRA) and Excepted Benefit HRAs (EBHRA). Under ICHRAs, individual coverage premiums would now be allowable expenses under the HRA, says John Barkett, senior director of policy affairs at Willis Towers Watson, which designs and delivers solutions that manage risk and optimize benefits. Under EBHRAs, short-term medical coverage would be an allowable expense.

Under ICHRAs, employees contract directly with a health plan. “The employer provides the funding, but that’s all,” Barkett says. “If an employee wants to keep their plan when they leave a job, they’re free to do so.”

  • Certain populations would benefit the most. Probably the most impacted population segment would be employees who work for employers with less than 50 full-time employees, because these employers aren’t required to offer health plan coverage under the ACA’s employer mandate and cannot under current rules set up HRAs that are not linked with major medical coverage, says Douglas Dahl, an employee benefits attorney with Bass, Berry & Sims. Under current rules, an employer of any size that offers a standalone HRA without underlying major medical coverage would be subject to ACA penalties. The proposed regulations change this for HRAs used to pay for individual health insurance coverage.

Populations that seek greater health coverage or less costly health insurance could also benefit most from the new regulation, says Saeed Aminzadeh, CEO, Decision Point Healthcare Solutions, a predictive analytics management company. An employer-sponsored plan may not be rich enough in terms of benefits for certain populations (e.g., the inclusion of richer, standalone dental benefits). Under the regulation, individuals would have greater flexibility to use an HRA to shop for and fund these types of coverages. Conversely, healthier individuals with limited health insurance needs may not want to share in the cost of a rich employer-sponsored health insurance plan. These individuals can have an opportunity to shop for a less costly, more limited insurance plan… Read More.