PPACA FAQs, Part 37 Released

On Jan. 12, 2017, the DOL, HHS and Treasury jointly released Frequently Asked Questions About the ACA’s Implementation, Part 37. The first two questions are related to integrated HRAs, while the remaining two questions provide mostly technical guidance aimed at insurers.

As a reminder, employers with 50 or more full-time equivalent employees can only offer an HRA if it is integrated with non-HRA (major medical) coverage. This means that:

  • The employer offers a major medical plan to any HRA eligible employees;
  • All HRA participants are enrolled in the employer’s group medical plan or another employer’s group plan; and
  • The employees are given the opportunity to waive the HRA.

Please note that this arrangement is different than the qualified small employer HRAs (QSEHRAs) that small employers (those with fewer than 50 FTEs) may sponsor as a result of the CURES Act. QSEHRAs can reimburse employees for individual policies but may not be integrated with group non-HRA coverage.

Under the second bullet above, those who are covered under the HRA, including a spouse and dependents, must be covered under a non-HRA group medical plan. Question #1 of the new FAQs clarifies that the non-HRA coverage may be sponsored by the employee’s spouse. The employer may rely upon the employee’s certification.

Question #3 clarifies that the family members covered under the integrated HRA may be covered under different non-HRA group plans. For example, the employee may be covered under his/her employer’s medical plan with self-only coverage, while the other family members are covered under the spouse’s employer’s medical plan.

The FAQs confirm and formalize prior guidance on the issue of HRA integration. Employers should review their HRA plan designs, if any, to ensure compliance.

ACA FAQ's, Part 37 »