Здоровье и выгоды: обзор планов возмещения медицинских расходов (HRA) в США

A Health Reimbursement Arrangement, also known as a Health Reimbursement Account (HRA), is a type of US employer funded health benefit plan that reimburses employees for out of pocket medical expenses and, in limited cases, to pay for health insurance plan premiums. An HRA is not truly an account, since it does not place funds under a separate legal title. Instead, it is an agreement under which the employee can submit qualified health expenses to the employer for reimbursement. Following implementation of the Affordable Care Act, HRAs must be integrated with a qualified employer sponsored group health insurance plan to avoid excise tax penalties. Using a Health Reimbursement Arrangement yields "tax advantages to offset health care costs" for both employees and employers.

In 2016, qualified small employer HRA (QSEHRA) were created which allows small employers to pay for premiums, including on the individual market such as through a health insurance marketplace, although the employees may not be eligible for subsidies.

In January 2020, a new type of HRA became available to businesses of all sizes that allows an employer to scale its benefits across nine different classes. This new tax advantaged tool is called an ICHRA (Individual Coverage HRA) and brings greater flexibility in design, expands upon the benefits that its predecessor, the QSEHRA, offered, and presents a potential solution to the issue of premium tax credits and HRA benefits that QSEHRAs posed. An ICHRA allows employers to reimburse their employees tax free for individual insurance and medical expenses. No more hassling with renewals, participation rates, stressing about doctor networks, or getting constant annual increases—just decide which benefits go to which classes of employees, set monthly allowance for each, and it's done. Employees get to choose any plan they want and flexible design criteria allows employers to customize their ICHRAs to suit their needs. Further, an ICHRA allows for applicable large employers (ALEs), when the ICHRA is deemed affordable for minimum value coverage, to meet the PPACA employer mandates. The HRA Council, a non partisan advocacy group made up of health insurance leaders, brokers, administrators, and organizations, released its first ICHRA report in October 2022. Using data from BenefitBay, Flyte HCM, HealthSherpa, HRASimple, Nexben, OneBridge Benefits, PeopleKeep, Stride Health, TakeCommand, and zizzl health, the HRA council found ICHRAs saw a 350% growth in popularity from 2020 to 2022.

Health Reimbursement Arrangements are funded solely by the employer; they cannot be funded through employee salary deductions. The employer sets the parameters for the Health Reimbursement Accounts, and unused dollars remain with the employer: they do not follow the employee to new employment.

Health Reimbursement Accounts are notional accounts; no funds are expensed until reimbursements are paid. By health reimbursement arrangements, employers reimburse employees directly only after the employees incur approved medical expenses. According to the IRS, an HRA "must be funded solely by an employer. Contributions cannot be paid through a salary reduction agreement (such as a cafeteria plan). While ICHRAs and integrated HRAs have no annual contribution limits, the QSEHRA is capped by the IRS. These limits are updated each year through IRS revenue procedure. For 2023, self only employees can receive employer contributions of up to $5,850. Employees with families can receive up to $11,800.