Fit & candidacy
How do I know whether a group is a strong ICHRA candidate? ▾
Strong candidates typically share a few characteristics: the employer is facing meaningful group plan renewal pressure, has employees in multiple states that a single carrier can't serve well, wants to offer benefits for the first time, or wants more cost predictability than a group plan provides. Workforce composition matters too — employers with a mix of full-time, part-time, or seasonal employees often find the class structure useful. Early pressure-testing through a census analysis is the most reliable way to confirm fit.
What are the 11 permitted ICHRA employee classes — and how can they be used? ▾
The 11 permitted employee classes give employers flexibility to apply ICHRA strategically, rather than as an all-or-nothing decision. For example, an employer might offer ICHRA to part-time employees who are difficult to cover economically under a traditional group plan while maintaining group coverage for full-time employees. A multi-state employer may use geographic rating area classes to account for different premium conditions across markets.
01
Full-time employees
Most common anchor class
02
Part-time employees
Offer a different allowance without excluding
03
Seasonal employees
Separate tier for seasonal workforce
04
Employees in a waiting period
New hire eligibility timing
05
Non-resident aliens with no US income
International employee handling
06
Salaried employees
Segment by pay structure
07
Hourly employees
Pair with salaried for different tiers
08
Employees in different states
Address cost differences by geography
09
Employees under a CBA
Carve out CBA employees if needed
10
Employees not yet past waiting period
Manage new hire benefit timing
11
Combination classes
Combine two or more permitted classes
In a conversation
When an employer says they can't afford to offer the same benefit to everyone — classes are the answer. Benafica builds class structure into the proposal based on the employer's workforce profile.
Can an employer offer ICHRA alongside a traditional group plan? ▾
Yes, employers may be able to offer ICHRA to certain permitted employee classes while offering traditional group coverage to others, provided class rules are structured appropriately. That can create flexibility for employers with different workforce populations or strategic objectives.
What is the difference between a QSEHRA and an ICHRA? ▾
QSEHRA is designed for smaller employers under 50 employees and includes annual contribution limits set by the IRS each year. ICHRA is available to employers of any size, has no contribution limits, and offers more flexibility around employee classes and contribution strategies. For most employers exploring an alternative to group coverage, ICHRA provides more options.
What happens with employees in multiple states? ▾
Multi-state workforces are often one reason employers explore ICHRA, since employees can access coverage available in their own local markets rather than fitting into a single group network. Because affordability and market conditions can vary by state, these cases usually benefit from contribution modeling and early pressure-testing.
What employer profiles may require extra pressure-testing before pursuing ICHRA? ▾
Employers with a combination of lower-income and older employees, those in markets with elevated individual premiums, workforces that are highly localized with access to strong group plan options, and employers with low change tolerance all warrant closer review before moving to a proposal.
Can I offer ICHRA to retirees or 1099 contractors? ▾
No. ICHRA is generally limited to active common law employees. It typically cannot be offered to retiree-only populations or independent contractors receiving a 1099.
What are common reasons employers decide not to move forward with ICHRA? ▾
The most common reasons include: the individual market in the employer's area doesn't offer enough plan options for employees; the employer contribution level isn't sufficient to make coverage practical for the workforce profile; employees are resistant to managing their own coverage selection; or the timing doesn't align with the group plan anniversary and deductible reset concerns are significant.
Affordability & compliance
How does ICHRA affordability work in practice? ▾
At a high level, affordability tests whether the employee's share of the premium for the lowest-cost silver benchmark plan, after the employer's ICHRA contribution is applied, does not exceed 9.96% of applicable wages under the 2026 threshold. This applies to ALEs (employers with 50 or more FTEs). Contribution modeling is often used early to help evaluate this.
How does ICHRA interact with ACA subsidies (APTCs)? ▾
Many ICHRA arrangements use off-exchange individual plans, which allows employees to use pre-tax employer contributions to pay for coverage. How subsidies interact with an ICHRA offer can depend on affordability and employee circumstances, which is often evaluated during plan design.
What happens if an ICHRA offer is not affordable for some employees? ▾
For ALE employers, affordability is a compliance requirement. Contribution modeling is used to confirm the offer meets the threshold for each employee class before the plan goes live. Benafica models this as part of every ALE proposal to identify any gaps before implementation.
Can employer contributions vary by age or family status? ▾
Yes. ICHRA allows employers to vary contribution amounts based on age and family status within a class. This flexibility is one of the ways employers can structure contributions to reflect real premium variation across their workforce without creating separate classes for every scenario.
How is COBRA supported under ICHRA? ▾
Benafica supports COBRA administration and helps individuals leaving a company understand their options, including whether they want to continue with their individual health plan through COBRA or explore another coverage path.
How does Benafica support ongoing compliance administration? ▾
Benafica handles legal plan documents, required employee notices, and ACA reporting support in-house. Ongoing compliance monitoring is part of the administrative service, not an add-on. Employers and brokers have visibility into compliance-relevant activity through the platform dashboard.
Funding & contribution modeling
How are contribution strategies typically modeled? ▾
Contribution modeling takes the employer's census — including employee demographics, ZIP codes, current plan tiers, and premium data — and maps it against available individual market plan costs by location. The goal is to identify a contribution level that is both affordable for the employer and workable for the employee population. For ALEs, the model also confirms ACA affordability compliance.
What is the difference between pre-funding and post-funding approaches? ▾
Benafica supports varying funding and administration approaches based on employer needs. Pre-funding and post-funding refer to when the employer's contribution is made available relative to when employee premiums are due. The right approach depends on the employer's cash flow preferences and administrative structure. This is evaluated during plan design.
Are there integrations with payroll? ▾
For employers with 50 employees or more, payroll integration can be offered as an additional pass-through service. Benafica partners with Finch, which supports 250+ pre-built payroll and HCM integrations.
What information is needed to run a proposal or contribution model? ▾
A full employee census including dependents is required: date of birth, ZIP code, current plan tier enrolled, waived employer premium amount, employee premium amount, and (for ALE employers) employee annual earnings.
How quickly can a census be modeled and a proposal prepared? ▾
Initial cost comparison is typically returned within 72 business hours of receiving a complete census. Complex situations — including ALE status, multi-state workforces, or contribution class stratification — may take up to 5 business days.
Employee experience & enrollment support
How do employees choose and enroll in coverage? ▾
With ICHRA, employees select their own individual or family plan rather than enrolling in a single employer-selected group carrier option. Employees can self-select coverage, but employers are encouraged to reinforce the resources available through Benafica's assigned licensed counselors. These counselors assist with plan selection, help verify doctors, prescriptions, and hospitals within plan networks, and support employees through the final steps of binding coverage and setting up autopay premium payments.
Do employees keep access to their doctors and networks? ▾
Employees choose their own individual plan, so network access depends on which plan they select. Benafica's licensed counselors help employees verify that their specific doctors, prescriptions, and hospitals are in-network before they finalize enrollment.
Who supports employees after enrollment if they have questions? ▾
The Benafica team and licensed counselors support employees with questions related to coverage, billing, or carrier issues. This year-round support is an important part of reducing friction for both the employer and their employees.
How are employees on Medicare treated? ▾
Employees approaching Medicare eligibility have access to licensed support for Medicare education, enrollment into Parts A and B, and assistance evaluating supplemental coverage options. Benafica proactively reaches out 4–6 months ahead of Medicare eligibility to help employees prepare and understand their options.
Does the platform support other languages? ▾
While the platform itself is in English, if another language is needed for employee support, licensed counselors can be provided who speak that language to support enrollment and ongoing service.
Administration, payments & reporting
How are premiums collected and remitted to carriers? ▾
Benafica manages the premium payment process, including collection from employers and remittance to carriers. The platform provides visibility into when payments are sent and when they clear, with real-time monitoring to identify and address discrepancies early.
What happens if an employee's premium payment is not recognized by the carrier? ▾
Benafica provides visibility to employers and brokers into when payments are sent to carriers and when those payments clear. This activity is monitored and audited in real time. Dedicated account teams monitor payment activity, identify issues early, and help resolve discrepancies before they become employee-level problems.
How are enrollment changes, terminations, and qualifying life events handled? ▾
Benafica manages mid-year enrollment changes, terminations, and qualifying life event (QLE) processing as part of ongoing administration. Employers and brokers have platform visibility into these changes as they occur.
Are there reports available for the broker or employer? ▾
Yes. Benafica provides platform dashboards with visibility into enrollments in progress, support tasks, employee carrier and plan selections, premium contributions and employee deductions, payment summaries including transaction history and invoices, and employer plan details with contribution schedules. Reporting can be exported to Excel.
How does the broker of record arrangement work with ICHRA through Benafica? ▾
Your BOR arrangement stays intact. Benafica operates as the ICHRA administrator and does not sit between you and the client relationship. Compensation flows through the CBIZ Alternative Benefits team structure with originating credit maintained for the producing broker or account manager.
How much administration falls back on the employer or broker? ▾
Benafica is designed to minimize the administrative burden on the employer. Plan documentation, employee communications, enrollment support, payment processing, and compliance administration are all handled by Benafica. The employer's primary role is confirming the contribution structure and communicating the change to their team.
How does Benafica differ from a tech-only ICHRA administrator? ▾
Tech-only platforms typically provide tools for self-service enrollment and administration but leave employee support and problem resolution to the employer or broker. Benafica combines platform technology with licensed counselors who support employees directly — through plan selection, enrollment, and ongoing questions.
Transition & change management
What are the options if an employer is mid-contract on a group plan? ▾
Many employers evaluate ICHRA around renewal, though some explore mid-year implementation depending on circumstances. One important consideration is that deductible accumulations do not carry over from a group plan into individual coverage, which can create disruption concerns for some workforces. For that reason, renewal often provides a cleaner point for evaluation.
How are deductible reset concerns handled in a mid-year transition? ▾
Deductible resets are one of the most common concerns when an employer considers a mid-year move. Employees who have been accumulating toward their deductible on a group plan would start over under individual coverage. In most cases, renewal-aligned implementation is the cleaner path.
How long does ICHRA implementation typically take? ▾
For employers transitioning from a traditional group plan to ICHRA, Benafica typically recommends allowing no less than 60 days, largely due to the communication and change management needed to support a smooth transition. For employers offering benefits for the first time, 45–60 days is often a reasonable planning window.
What communication support is available to help employers roll out ICHRA? ▾
Benafica provides employee communication support as part of the implementation process, including materials that help employees understand what is changing, how to select coverage, and where to get help.
What change management considerations should employers plan for? ▾
The most common change management challenges are: employees unfamiliar with individual market shopping; concern about losing a familiar group plan and carrier; and uncertainty about what support is available if problems arise. Addressing these early — through clear communication, counselor access, and realistic timelines — significantly reduces transition friction.
How are employee concerns typically addressed during transition? ▾
Benafica's licensed counselors work directly with employees during the transition period — helping them understand their options, compare plans, verify their doctors and prescriptions, and complete enrollment.
What communications materials can brokers and employers use with employees? ▾
Benafica provides communication materials that can be used directly with employees, including enrollment guides and plan selection resources. Co-branded materials for CBIZ producers are available through the resource library.