What CAN be Eligible
As an employer, you can choose what you want your ICHRA to reimburse. You may choose from two options:
- Insurance premiums only.
- Insurance premiums and qualified medical expenses.
Insurance premiums only:
You can choose to elect from medical, dental, vision premiums, or any combination of those. The ICHRA can also be used to pay for Medicare (but Medicare cannot be its own funding class).
Insurance premiums and 213(d) expenses:
Employees must have active coverage for any month they incur a 213(d) expense for it to be eligible. If you elect this option, the employee's ICHRA can reimburse any eligible 213(d) expense. The list of eligible expenses is outlined in the IRS Publication 502 but includes items such as:
- Doctor visits
- Co-pays
- Prescriptions
- Over-the-counter drugs
- Dental procedures
- Hospital bills
- Vaccines
- Lab tests
- Etc.
What CANNOT be Eligible
An ICHRA cannot be used to be reimbursed for or pay for Excepted Benefits (or cannot pair with an EBHRA).
Examples of additional ineligible expenses:
- Toiletries
- Acne treatments
- Lip balm
- Cosmetics
- Suntan lotion
- Vitamins
- Fiber supplements
- Dietary supplements
- Weight loss drugs for general well being
- Premiums for life insurance
- Income protection
- Disability
- Loss of limbs
- Sight or similar benefits
