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HHS Finalizes Exchange Rules for Premium Payments Made by ICHRAs and QSEHRAs


· 5 minute read


· 5 minute read

PPACA; HHS Notice of Benefit and Payment Parameters for 2022; Updates To State Innovation Waiver (Section 1332 Waiver) Implementing Regulations; Final Rule, 45 CFR Parts 155 and 156, 86 Fed. Reg. 6138 (Jan. 19, 2021); Notice of Benefit and Payment Parameters for 2022 Final Rule Fact Sheet


Fact Sheet

HHS has finalized several of the regulations for insurance markets and Exchanges that were included with the proposed 2022 benefit and payment parameters (see our Checkpoint article). Tucked in with other finalized Exchange rules (including requirements for direct enrollments, network adequacy, and state innovation waivers) are final regulations with Exchange standards for individual coverage HRAs (ICHRAs) and qualified small employer HRAs (QSEHRAs).

Effective March 15, 2021, HHS will require individual market insurers of qualified health plans to accept payments made on behalf of an enrollee from an ICHRA or QSEHRA that are made using a monthly premium payment method that insurers are required to accept under existing Exchange rules (e.g., paper checks, money orders, and pre-paid debit cards). In addition to accepting direct payments from an ICHRA or QSEHRA, insurers must accept premium payments made directly by ICHRA and QSEHRA enrollees using funds from an ICHRA or QSEHRA and one of the existing payment methods. The regulations recognize that some ICHRAs and QSEHRAs prefer to make aggregate payments on behalf of multiple employees to Exchange insurers, and are intended to encourage insurers to work with employers and administrators to facilitate these payments. HHS points out, however, that the regulations do not require insurers to accept aggregate payments from ICHRAs and QSEHRAs.

EBIA Comment: The preamble notes that this portion of the regulations is intended to help overcome insurers’ confusion about whether they must accept payments from an ICHRA or QSEHRA, which commenters stated has been an obstacle to the implementation of these payment options. HHS reported receiving multiple comments criticizing the short length of the comment period and expressing concern that HHS had rushed to finalize the rules. HHS responded that it had focused only on certain policies in the proposed regulations to expedite publication of final regulations. For more information, see EBIA’s Health Care Reform manual at Section XXI (“Exchanges, Qualified Health Plans, and Premium Tax Credits”). See also EBIA’s Consumer-Driven Health Care manual at Sections XXVII (“Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs)”) and XXVIII.B (“Individual Coverage HRAs (ICHRAs)”).

Contributing Editors: EBIA Staff.

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