Welcome to the Agent and Broker Video Learning Center.
This video will provide a walkthrough of the
streamlined HealthCare.gov application to highlight new application features:
Attesting to an offer of an individual coverage Health Reimbursement Arrangement, or HRA
from an employer.
The effect of that offer on the applicant’s eligibility for savings and a Special Enrollment Period
For a walkthrough of the application where the household is offered health coverage
through their employer, watch our other video “Streamlined Marketplace Application
Walkthrough – Applicant Offered Employer-Sponsored Coverage” linked in the description below.
In this video, the term "Marketplace" refers to Federally-Facilitated Marketplaces,
or FFMs, including FFMs where states perform plan management functions and State-Based
Marketplaces on the Federal Platform, or SBM-FPs.
This scenario features Maya, who is applying for
coverage through the Marketplace and seeking savings to reduce the cost of her coverage.
As of January 1, 2020, employers can now offer individual coverage health reimbursement
arrangements, or individual coverage HRAs, to eligible employees to reimburse medical expenses,
including the cost of individual health insurance coverage.
Please note, consumers may not use a cafeteria plan to pay the portion
of the Marketplace premiums not covered by an individual coverage
HRA. Cafeteria plans may only be used towards coverage purchased outside the Marketplace.
Maya is newly offered an individual coverage HRA, so she is applying for individual coverage through
the Marketplace. Maya will answer questions to help determine if she is eligible for savings
and a Special Enrollment Period.
Maya is a 25-year-old applying for coverage outside of Open Enrollment in Dallas County, Texas.
Maya will file taxes for the coverage year and expects to earn $30,000 annually.
Maya received a notice from her employer on April 30th, 2020
informing her that she’s offered an individual coverage HRA
that will begin on August 8th, 2020 and will continue through the end of the year.
Maya may be able to receive savings through the Marketplace based on the information
she has entered up to this point, so she’ll answer a few more questions
to help determine if she’s eligible for savings or a Special Enrollment Period.
Most of the information Maya will need to provide regarding HRAs to the Marketplace
is in the notice she received from her employer,
so she should reference this notice as she continues through the application.
Before she answers questions about any traditional job-based health coverage or health reimbursement
arrangements, or HRAs, available to her through her employer, Maya reviews information about
the differences between the two different types of coverage available through a job.
Based on this information, Maya knows to reference the notice from her employer when she sees the HRA
notice icon throughout the application. Maya also reviews information about the
differences between individual coverage Health Reimbursement Arrangements and Qualified Small
Employer Health Reimbursement Arrangements, or QSEHRAs.
Maya can determine which type of HRA she has, if she has been offered or provided either,
by referencing the notice from her employer. After providing her household information and
expected income, Maya is asked if she already has an individual coverage HRA.
Maya doesn’t meet the criteria for being currently enrolled in an HRA, so she selects
“No” and continues to the next question. Maya is asked whether she has an individual
coverage HRA offer that she has not yet accepted and can still decline or “opt out” of.
Maya’s employer, ABC Inc., offers Maya an individual coverage HRA that begins
fifteen days from today, August 8th, 2020, but Maya hasn’t let her employer know
if she’ll accept the offer, so Maya selects ”Yes” here.
First, based on the notice Maya’s employer sent her, Maya knows that she’ll be able to use the
individual coverage HRA two months from today, so Maya will select “Yes” for this question.
Then, Maya is asked which employer offers her the individual coverage HRA.
The names of the employer Maya entered have been added to the application.
If there were additional household members on the application, then all employers entered
with their income information will automatically populate on this page.
In this case, Maya is the only household member on her application, so she’s able to select that her
employer, ABC Inc., offers her an individual coverage HRA. Since Maya’s employer offers an
individual coverage HRA that starts on August 8th, she selects “ABC Inc.,” and then selects
“Save & continue” to proceed to more questions about her individual coverage HRA offer.
If Maya’s individual coverage HRA came from another employer,
Maya would provide information about that employer here by selecting “Add an employer.”
Next, Maya will provide information about the individual coverage HRA offer,
including its start and end dates.
This information is available in the notice Maya’s employer is required to provide her. If Maya has
additional questions about her individual coverage HRA offer, she should check with her employer.
In this case, Maya’s individual coverage HRA will start fifteen days from now,
August 8, 2020 and will continue through the end of the year to December 31, 2020,
so she’ll enter both dates on this page. Maya will select “Save & continue” to
continue answering questions about her individual coverage HRA offer.
Finally, Maya will be asked to enter the dollar amount of reimbursement
funds that are available for her through her individual coverage HRA offer from ABC, Inc.
This information will be used to determine Maya’s eligibility for Marketplace savings.
If Maya’s offer of individual coverage HRA makes purchasing coverage through the Marketplace
affordable, then Maya won’t be eligible for savings, even if she doesn’t accept the offer.
In this case, amount of reimbursement available to Maya only is $50 a month, so she will enter
“$50.00” and select “monthly” when asked how often this amount will be available.
Maya can learn more about whether her individual coverage HRA is affordable
through the Centers for Medicare & Medicaid Services’ individual coverage HRA tool.
Maya will be asked to provide the contact information of the person
at her job who manages employee benefits. Although only a phone number is required,
she enters the phone number, email address, name, and address of this person at her job.
After providing her employer’s contact information,
Maya will be asked if she is also offered traditional health coverage through her job.
Please note, traditional health coverage through a job is a health plan, or plans,
offered to an employee, and often their household members, by an employer.
The employer may take premiums out of the employee’s paycheck. In contrast,
Health Reimbursement Arrangements ,or HRAs, through a job are account-based reimbursements for
qualified medical expenses, including premiums for individual health insurance, rather than plans.
For more help on completing this section, Maya can select the “Get help completing
this section” and “Learn more about who’s offered job-based coverage”
links to view more information on the difference between traditional health coverage and HRAs.
Maya knows she should only enter information about traditional
health coverage through a job here. She should not enter information on HRAs here.
Maya is only offered a Health Reimbursement Arrangement by her employer. She is not offered
traditional health coverage through her job or through the job of another person, so she will
select “No” on this page and continue to answer questions about life events and coverage changes.
For more information on job-based coverage, watch our other video
linked above and in the video description.
Before answering questions about life events and coverage changes,
Maya reviews information about coverage changes that may affect her coverage options.
Because Maya is newly offered an individual coverage HRA through her employer,
she’ll provide more information about her offer.
These questions are used to determine Maya’s eligibility to enroll in coverage outside of Open
Enrollment through a Special Enrollment Period. If Maya is newly offered an individual coverage HRA,
then the Marketplace may find Maya eligible for a Special Enrollment Period.
In this case, the start date of Maya’s HRA is 15 days from now,
August 8, 2020, so she’ll select “Yes” for this application question.
Maya will then be asked more about her HRA offer. She knows that she’s been offered an
individual coverage HRA, rather than a qualified small employer HRA, or “QSEHRA,” because it’s
stated in the notice from her employer, so she’ll select “individual coverage HRA.”
Maya will select “Save & continue” to continue in the application.
Maya received notice from her employer 85 days before today,
April 30, 2020, informing her about the individual coverage HRA offer, its start and end dates,
and the amount of reimbursement available to her. She’ll enter the date the notice was sent here.
Based on the notice provided to Maya by her employer, she knows that her individual
coverage HRA will begin in August, so she enters August 8th, 2020, as the start date.
Maya isn’t currently enrolled in an HRA through ABC, Inc.,
so she attests “No” to the question asking whether she already has an individual coverage HRA.
Maya selects “Save & continue” to proceed through the rest of the application
and submit for an eligibility determination.
Based on the information collected in the application,
Maya is eligible to enroll in a Marketplace plan.
Because the Marketplace calculated that Maya’s reimbursement through her individual coverage HRA
would not make Marketplace coverage affordable, Maya is also eligible for savings.
If Maya wants to use her savings through the Marketplace, Maya should decline or “opt out”
of her individual coverage HRA
If Maya’s reimbursement through her individual coverage HRA had
made Marketplace coverage affordable, Maya would not have been eligible for savings.
In that case, she could accept her individual coverage HRA,
and use the reimbursements to help pay for her Marketplace premiums.
Additionally, because Maya is newly offered an individual coverage HRA that’ll begin in
the next two months, Maya is eligible to enroll in coverage outside the Open Enrollment Period
through a Special Enrollment Period. Maya is eligible to enroll in coverage until August 7, 2020,
the day prior to her individual coverage HRA’s start date.
Please note, consumers like Maya who are newly offered a Qualified Small Employer HRA
or Individual Coverage HRA may be eligible for this Special Enrollment Period
even if they opt out of their Health Reimbursement Arrangement.
We hope this video has been helpful. If you haven’t already, we encourage you to watch
our other videos for a full walkthrough of the streamlined HealthCare.gov application
in which the applicant is seeking savings to reduce the cost of their coverage and is offered
traditional health coverage from their employer, linked to in the video description below.
If a consumer needs additional support in answering application questions about their
offer of an individual coverage HRA, they should contact the Marketplace Call Center.