And Your Answer Is…………..□ YES □ NO
The correct answer (and we’re standing by it!) is………. ☑ YES.
If true, and we believe it is, this means a large group ICHRA plan can obtain their claim information. The problem is no one seems to know that, not even the insurance companies offering the coverage.
In case you’re skeptical here’s some backup:
Large group employers (50+ employees) sponsoring group health insurance can obtain their claim experience upon demand twice a year made possible by Texas House Bill 2015.
An ICHRA (Individual Coverage Health Reimbursement Arrangement) is a group health plan that allows employers to offer tax-free dollars to employees to spend on or off the Individual Marketplace. Employers with ICHRAs must comply with ERISA’s reporting and disclosure rules and fiduciary responsibilities.
Applicable government definitions of group plans include:
Group health plan (also see definition of health plan in this section) means an employee welfare benefit plan (as defined in section 3(1) of the Employee Retirement Income and Security Act of 1974 (ERISA), 29 U.S.C. 1002(1)), including insured and self-insured plans, to the extent that the plan provides medical care (as defined in section 2791(a)(2) of the Public Health Service Act (PHS Act), 42 U.S.C. 300gg-91(a)(2)), including items and services paid for as medical care, to employees or their dependents directly or through insurance, reimbursement, or otherwise, that:
(1) Has 50 or more participants (as defined in section 3(7) of ERISA, 29 U.S.C. 1002(7)); or
(2) Is administered by an entity other than the employer that established and maintains the plan.
The terms “employee welfare benefit plan” and “welfare plan” mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) med ical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, dis ability, death or unemployment, or vacation benefits, apprenticeship or other training programs, or day care centers, scholarship funds, or prepaid legal services…….
Are ICHRA group plans eligible for return of premium under the ACA Minimum Loss Ratio requirement?
.□ YES OR □ NO
The Affordable Care Act (ACA) requires health insurers to spend a minimum of 80-85% of premiums on medical care. Insurance companies must return any excess premiums if they do not meet this requirement by September 30 of the following year.
ICHRA is a fully insured group plan.
The answer is ☑ YES. However, the Minimum Loss Ratio mandate is not group specific.
Why would an ICHRA plan sponsor want to track their claim experience?
Nothing is forever. At some point an ICHRA plan sponsor may want to explore alternatives. Having access to their claim data can give them a competitive advantage.
What are the penalties for non-compliance?
A health insurance issuer must deliver the requested claim information within 30 calendar days after receiving a written request from a plan, plan sponsor, or plan administrator
The penalties for non-compliance with HB2015 Texas Claim Experience can include daily fines up to $591 per day for each day the report is late, capped at $10,000
