Understanding the ICHRA affordability rules that accompany the individual coverage health reimbursement arrangement (ICHRA) will go a long way in ensuring that employers are getting the most benefits out of this tax-advantaged tool. Let’s look at the most recent affordability rates and the ICHRA affordability rules to remember.
The Affordable Care Act (ACA) requires employers with more than 50 full-time equivalent (FTE) employees to provide health insurance to their employees. This is known as the “employer mandate." Employers that don’t provide affordable insurance are subject to steep penalties.
ICHRA satisfies the ACA’s employer mandate if the offer is “affordable."
The catch? The ICHRA has to be “affordable” to meet the mandate and clear the employer of any penalties. This makes sense, as otherwise employers could offer $1/mo and escape the penalty which would be unfair to employees.
Since employers cannot ask their employees outright what their annual household income is, the IRS has set forth three safe harbors employers can use to calculate affordability.
In order to determine ICHRA affordability we need to determine the lowest cost self-only silver plan on the marketplace.
An ICHRA is affordable if the remaining amount an employee has to pay for a self-only silver plan on the exchange is less than 9.61% of the employee’s household income for 2022. 2023 ICHRA Affordability rates will be slightly downward at 9.12%.
Insurance premiums are driven by location and age of insured. To allow employers to estimate the cost of plans for their employees, the IRS has allowed the following safe harbors to determine lowest cost silver plans for each employee.
Confused? Our ICHRA Affordability Calculator allows you to upload an employee census to our site and we can run a free affordability analysis for you.
You can also check out the section on affordability in our comprehensive ICHRA guide.
Once a year the employee has the option to opt-out of ICHRA. If the ICHRA offering is deemed unaffordable to the employee the employee has the option to still participate in the ICHRA or opt-out of the ICHRA and accept a premium tax credit (PTC) from the marketplace.
Applicable Large Employers (ALE) may be liable for ACA penalties for not providing affordable coverage.
Want to learn more? Check out our ICHRA guide or chat with one of our HRA experts online to guide you through our ICHRA Administration platform. We'd be happy to help!