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Small Business

Individual Integrated HRAs: How Do They Work?

Individual Integrated HRAs: Understanding Their Mechanics


Health Reimbursement Arrangements (HRAs), especially individually integrated ones, have become a pivotal element in the modern health benefits landscape. They offer employees a unique blend of flexibility, cost efficiency, and personalized healthcare benefits. This type of HRA, precious for small to medium-sized businesses, allows employers to reimburse their employees for health insurance premiums and medical expenses on a tax-advantaged basis. Understanding how integrated HRAs function can empower employers and employees to make informed decisions about health care benefits.

What is Integrated Health Care?

At its core, integrated health care represents a holistic approach to health services, emphasizing the coordination and integration of health care services to provide more efficient, effective, and patient-centered care. In the context of health insurance and benefits, integrated health care often refers to the seamless combination of various health insurance products and health services to meet individuals' comprehensive needs.

What About Integrated HRAs?

Integrated Health Reimbursement Arrangements (HRAs) are designed to work in tandem with individual health insurance policies. Unlike traditional group health insurance plans, these HRAs allow employees to choose their health insurance coverage, which the employer can reimburse through the HRA. This integration offers several key benefits:

  • Personalization: Employees can select health insurance plans that best fit their personal or family needs rather than being limited to one or a few options an employer provides.
  • Cost Control for Employers: Employers can control costs by setting caps on the reimbursement amounts through the HRA instead of bearing the total cost of a group health insurance plan.
  • Tax Advantages: Reimbursements made through HRAs for qualified medical expenses, including premiums for individual health insurance, are tax-free for employees and tax-deductible for employers.
  • Flexibility and Choice: This setup offers a broader choice of healthcare providers and employee plans, potentially leading to better satisfaction and engagement.
  • Ease of Administration: Employers can benefit significantly from the simpler administration of an HRA compared to traditional health insurance when leveraging platforms designed to manage HRAs.

Individual integrated HRAs, particularly Individual Coverage HRAs (ICHRAs), have gained popularity as they align with the current health insurance market's trends toward greater personal choice and control. They stand out as an innovative solution for businesses looking to provide meaningful health benefits cost-effectively and flexibly. Understanding the interplay between individual health insurance and HRAs can help employers craft a benefits package that supports the health and well-being of their employees while managing the bottom line.

What are the Benefits of an Individual Integrated HRA?

The introduction of Individual Coverage Health Reimbursement Arrangements (ICHRAs) has revolutionized how small businesses can offer health benefits to their employees. This innovative approach provides a host of advantages that align with the needs of both employers and employees, offering a balanced solution in the ever-evolving landscape of health insurance. Here's a closer look at the key benefits of adopting an Individual Integrated HRA for your business:

Budget Friendly

One of the most appealing aspects of ICHRAs for small businesses is their budget-friendly nature. Employers can set their budgets by deciding how much they want to contribute to their employees' health coverage each month. This model allows for predictable health benefit costs, enabling businesses to manage their finances more effectively without the unpredictability of traditional group health insurance premiums.

Tax Advantages

ICHRAs offer significant tax benefits for both employers and employees. Employers can deduct their contributions to the HRA from their taxes, reducing their overall tax liability. Employees' reimbursements for qualified health care expenses, including individual health insurance premiums, are tax-free. This tax efficiency makes ICHRAs an attractive option for maximizing the value of health benefits.


The flexibility of ICHRAs is unmatched, catering to the workforce's diverse needs. Employees can select the health insurance plans that best suit their personal or family health care needs. This means they are not limited to the one-size-fits-all plans typically offered under group health insurance, allowing for more personalized and relevant health coverage. Additionally, ICHRAs can be designed for employees, such as full-time, part-time, or seasonal workers, providing tailored benefits that reflect the nature of their employment.

Employee Retention

In today's competitive job market, offering attractive health benefits is crucial for retaining talent. ICHRAs represent a significant perk for employees, demonstrating the employer's investment in their health and well-being. This personalized health benefits approach can increase employee satisfaction and loyalty, making it easier for businesses to retain their valued team members. Moreover, the ability to offer health benefits that are both flexible and valuable can also enhance a company's appeal to prospective employees, aiding in recruitment efforts.

Overall, Individual Integrated HRAs offer a modern solution for small businesses looking to provide health benefits. By combining budget control, tax benefits, flexibility, and the potential to boost employee retention, ICHRAs stand out as a strategic choice for businesses aiming to navigate the complexities of health insurance while prioritizing the well-being of their workforce.

Simplified Administration

HRAs typically require less administrative effort than traditional group health insurance plans. With tools and platforms designed to manage HRAs, employers can easily set up their HRA, define contribution limits, and automate much of the reimbursement process. This simplification reduces the burden on small business owners, allowing them to focus more on running their business rather than on complex benefit administration tasks.

Compliance Ease

Navigating the compliance requirements of offering health benefits can be daunting for many small businesses. HRAs, particularly ICHRAs, are structured to align with current health insurance regulations, offering a compliant solution for providing health benefits. This can offer employers peace of mind, knowing they are meeting their legal obligations while providing valuable benefits to their employees.

Improved Healthcare Access

HRAs can significantly improve access to healthcare by reimbursing employees for their health insurance premiums and medical expenses. Employees are more likely to enroll in health insurance and seek necessary medical care when they know they have financial support from their employer. This can lead to better overall health outcomes for employees, reducing absenteeism and increasing productivity in the workplace.

Cost Transparency

HRAs promote cost transparency in healthcare spending. Since employees can see the cost of their healthcare services and insurance premiums, they are more likely to make informed, cost-effective decisions. This awareness can lead to more prudent use of healthcare resources, benefiting both the employee, who maximizes their HRA funds, and the employer, who can better predict and control health benefit costs.


A unique advantage of individual coverage through HRAs is the portability of health insurance. Unlike traditional employer-sponsored group plans, where coverage ends when an employee leaves the company, the health insurance policies employees purchase with HRA funds are theirs to keep. This portability is particularly valuable in today's dynamic job market, giving employees peace of mind that their health coverage is not tied to their job status.

Enhances Employee Choice and Satisfaction

An HRA, especially an ICHRA, empowers employees to select the health insurance plan that best fits their needs and preferences. This level of autonomy and personalization can significantly enhance employee satisfaction with their benefits package, as they feel more in control of their healthcare decisions.

Incorporating these additional benefits into the discussion on HRAs emphasizes the comprehensive value these arrangements bring to small businesses and their employees. By providing a solution that is not only financially viable but also promotes healthcare access, simplifies administration, and enhances employee satisfaction, HRAs represent a forward-thinking approach to health benefits in the modern workplace.

What are the requirements for an Individual Integrated HRA?

The proposed rules would require that several conditions be met for the Individual Integrated HRA to qualify:

  • A health insurance plan must cover individual employees (and their dependents)
  • The design of the HRA does not intentionally or unintentionally discriminate (to prevent risk shifting)
  • Employees in the same "employee class" are offered an HRA on the "same terms."

Who can use an integrated HRA?

The proposed employee classes in regulations include:

  • Full-Time Employees
  • Part-Time Employees
  • Seasonal Employees
  • Employees covered by a collective bargaining agreement
  • Employees who have not satisfied a waiting period for coverage
  • Employees under age 25
  • Non-Resident aliens with no US-based income
  • Employees whose primary site of employment is in the same rating area

This means that employers could offer different reimbursement amounts or even different types of coverage to different classes of employees. This is a big upgrade over QSEHRA, which allows employers to choose whether to include or exclude classes of employees similar to the list above but not to offer different offerings.

For example, under the proposed rules, employers could offer full-time employees a traditional group plan and part-time employees an Individual Integrated HRA. Or employers could offer an HRA with certain reimbursement rates to an office in one geography and a different HRA with different reimbursement amounts to an office in another location (based on the rating area criteria above).

How does an Integrated HRA work? 

An Integrated Health Reimbursement Arrangement (HRA), particularly the Individual Coverage HRA (ICHRA), offers employers a streamlined and flexible approach to providing health benefits. Understanding how an integrated HRA works can help employers and employees grasp its benefits and functionalities. Here’s a step-by-step breakdown:

Step 1: Employer Setup

  • Determine Eligibility: The employer decides which employees are eligible for the HRA. This can include full-time, part-time, seasonal employees, or a specific class of workers.
  • Set Reimbursement Limits: The employer establishes the HRA's monthly or annual contribution amounts. These limits can vary based on employee categories, such as family size or job status.
  • Choose a Plan Year: Employers define their HRA plan year's start and end dates, aligning it with their fiscal year or the calendar year for convenience.

Step 2: Employee Participation

  • Select Individual Health Insurance: Employees choose and purchase their individual health insurance plan from the marketplace, broker, or directly from an insurer. The chosen plan must qualify as minimum essential coverage to be eligible for reimbursement through the HRA.
  • Submit Proof of Expenses: Employees submit evidence of their health insurance premiums and other qualified medical expenses to their employer or the HRA administrator for reimbursement.

Step 3: Reimbursement Process

  • Review and Approval: The employer or HRA administrator reviews the submitted documents to ensure they meet the HRA’s eligibility criteria.
  • Tax-free Reimbursement: Once approved, employees are reimbursed for their eligible expenses up to the maximum contribution limit set by the employer. These reimbursements are made on a tax-free basis, providing a significant advantage over taxable income.

Step 4: Ongoing Management

  • Record Keeping: Employers must keep detailed records of all HRA contributions and reimbursements for tax purposes and to ensure compliance with healthcare regulations.
  • Adjustments and Updates: Employers can adjust contribution limits and eligibility criteria at the beginning of each new plan year, based on their budget and employees' needs.

Compliance and Communication

  • Legal Compliance: Employers must ensure their HRA complies with current healthcare laws, including Affordable Care Act (ACA) requirements and Internal Revenue Service (IRS) regulations.
  • Employee Communication: Employers are responsible for informing employees about the HRA, including how to participate, what expenses are eligible, and the reimbursement process. Clear communication is crucial for maximizing the value of the benefits to employees.

Integrated HRAs, like ICHRAs, represent a shift towards more personalized and flexible health benefits. They allow employers to support their employees' healthcare needs without the financial unpredictability of traditional group health plans. This model benefits employers by offering cost control and tax advantages while allowing employees to choose their healthcare coverage and ensuring their medical expenses are supported.

What can an Integrated HRA help pay for? 

The Individual Integrated HRA is designed to help employees pay for individual health insurance premiums. In addition, it can also help pay for medical expenses provided that the employee has substantiated he or she has health insurance coverage. This is similar to the rules in effect governing QSEHRA.

Is there a minimum or maximum number of employees needed for Integrated HRA?

For Individual Coverage Health Reimbursement Arrangements (ICHRAs), regulations do not impose minimum or maximum employee count requirements. This makes ICHRAs an accessible option for businesses of all sizes, from small startups with just a few employees to large corporations with thousands of employees.

The flexibility of ICHRAs extends to their applicability across different business sizes and types, allowing any employer to offer this type of health benefit regardless of the number of employees. This inclusivity makes ICHRAs particularly appealing; they provide a way for employers to support their employees' health insurance needs without the constraints and complexities often associated with traditional group health insurance plans.

Whether a business is looking to offer health benefits for the first time or seeking an alternative to its current offering, ICHRAs provide a scalable solution that can be customized to fit the unique needs of the employer and its workforce. Employers considering an ICHRA should focus on designing their arrangement to meet their objectives and compliance requirements rather than concerning themselves with meeting a specific employee threshold.

What are the contribution limits?

For Individual Coverage Health Reimbursement Arrangements (ICHRAs), one of the most appealing features is that regulations impose no set contribution limits. Employers can decide how much they want to contribute to their employees' ICHRAs. Businesses of any size can tailor their contributions according to their budgetary constraints and benefits strategies.

This flexibility allows employers to design their ICHRA offerings in a way that best meets the needs of their workforce while also managing their own financial planning effectively. Employers can set different contribution amounts based on employee classifications, such as full-time vs. part-time status, job role, or family size, giving them control over their benefits spending.

It's also worth noting that while employers can freely choose their contribution levels, once set, these contributions must be consistent among employees within the same classification to comply with nondiscrimination requirements. Employers looking to implement an ICHRA should consider consulting with a benefits advisor or legal counsel to ensure their plan is designed in compliance with all applicable regulations and to make the most of the flexibility ICHRAs offer. 

Can large employers offer an Individual Integrated HRA to meet the corporate mandate?

Large employers can offer an Individual Coverage Health Reimbursement Arrangement (ICHRA) to meet the corporate mandate under the Affordable Care Act (ACA). The ACA requires large employers—those with 50 or more full-time equivalent employees—to offer health insurance that is affordable and provides minimum value or face potential penalties. ICHRAs offer a flexible solution for these employers to fulfill this mandate.

By offering an ICHRA, large employers can reimburse employees for the cost of individual health insurance premiums and other qualified medical expenses on a tax-advantaged basis. This arrangement allows employees to purchase their own health insurance on the open market, allowing them to select a plan that best meets their needs. For the ICHRA to satisfy the employer mandate, the offer must be considered affordable according to ACA guidelines, which involve specific calculations based on the employee's household income and the HRA contribution.

The introduction of ICHRAs includes regulations that allow these arrangements to integrate seamlessly with the ACA's requirements, making them a viable option for large employers to comply with the law while providing flexibility and choice to their employees. Employers considering an ICHRA should ensure their plan design meets all regulatory requirements, including affordability and minimum value standards, to satisfy the corporate mandate under the ACA fully.

Can an Individual Integrated HRA work with other types of HRAs?

Because an Individual Integrated HRA requires no group health plan be offered to the same class of employees, we know it will not work with the new Excepted Benefits HRA or with traditional Section 105 HRAs integrated with a group health plan. It may be able to work with QSEHRA but the benefits would likely be redundant.

However, the proposed rules do allow employers to offer different benefit solutions to different classes of employees (assuming the classes are defined in a fair manner). An employer could offer an Excepted Benefits HRA to one class (say, part-time employees) and a QSEHRA to full-time employees.

When can I set up an Individual Integrated HRA?

You can set up an Individual Coverage Health Reimbursement Arrangement (ICHRA) at any point during the year, offering a flexible option for businesses ready to provide health benefits to their employees. While the setup itself can be initiated anytime, it's wise to consider the individual health insurance market’s open enrollment period to align your ICHRA start date, facilitating more accessible plan selection for your employees. Employers must notify employees about the ICHRA at least 90 days before the plan starts, detailing contribution amounts and participation instructions for new hires or those newly eligible. Special enrollment periods allow health plan selection outside the typical open enrollment window. If starting an ICHRA mid-year, consider prorating the annual contributions for simplicity and budget management. This adaptability makes ICHRAs a practical and appealing choice for businesses anytime, ensuring employees have access to personalized health benefits when needed.

How is it different from a stand-alone HRA?

An Individual Coverage Health Reimbursement Arrangement (ICHRA) presents a modern approach to employer-funded health benefits, distinctively different from traditional stand-alone HRAs in several key aspects:

  • Integration with Individual Health Insurance: Unlike stand-alone HRAs often used to complement a group health plan or as the sole health benefit, ICHRAs are designed to integrate with individual health insurance policies. Employees must have personal health insurance coverage through the marketplace, a private plan, or Medicare to be eligible for reimbursement through an ICHRA. This requirement underscores the ICHRA's flexibility and personalized benefit approach, allowing employees to choose plans that best fit their needs.
  • Regulatory Compliance and Flexibility: Stand-alone HRAs, due to their structure, faced restrictions under the Affordable Care Act (ACA), particularly around annual limits on benefits and the requirement to offer preventive services at no cost. ICHRAs, however, were created to comply with ACA regulations, offering a compliant way for employers of any size to reimburse employees for health insurance premiums and medical expenses tax-free. This makes ICHRAs a more flexible and adaptable solution for businesses seeking health benefits under current laws.
  • Eligibility and Contributions: ICHRAs offer a higher degree of customization regarding eligibility and contribution amounts. Employers can set different reimbursement rates based on employee classifications, such as full-time, part-time, or seasonal status and family size. This level of customization was less feasible with traditional stand-alone HRAs, which typically offered a one-size-fits-all contribution model.
  • Employee Choice and Portability: The individual health insurance coverage reimbursed through an ICHRA is chosen by the employee, promoting personal choice and responsibility in healthcare decisions. This contrasts with the limited options typically available under a stand-alone HRA associated with a group health plan. Additionally, the health insurance policy an employee chooses is portable and remains with them if they change jobs, offering continuity of care that stand-alone HRAs cannot provide.

In summary, ICHRAs distinguish themselves from stand-alone HRAs by their integration with individual health insurance, compliance with ACA regulations, customizable contributions and eligibility, and promotion of employee choice and portability of coverage. These differences underscore the ICHRA's role as a flexible, personalized, and regulation-compliant health benefit solution for modern businesses.




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