Frequently Asked Questions

Eligibility depends on the HRA type and written plan terms. Group-integrated HRAs require qualifying group coverage; ICHRAs require qualifying individual insurance or Medicare. QSEHRAs are for eligible non-ALE employers that offer no group health plan, with minimum essential coverage needed for tax-free reimbursements. Excepted-benefit HRAs require an offer of traditional group coverage but not enrollment in it. Self-employed persons generally cannot participate. Sources: IRS Publication 969; CMS, Individual Coverage and Excepted Benefit HRA FAQs; HealthCare.gov, QSEHRA guidance.

It depends on the arrangement. Group-integrated HRAs supplement qualifying group coverage; ICHRA and QSEHRA follow different coverage and employer rules. An HSA-qualified HDHP alone does not make an HRA compatible with HSA contributions. General-purpose HRA coverage generally prevents contributions; certain limited-purpose, post-deductible or suspended designs may preserve eligibility. Confirm the combination and all other HSA eligibility requirements before employees contribute. Source: IRS Publication 969; CMS, Individual Coverage and Excepted Benefit HRA FAQs.

HRA cost has two parts: reimbursements the employer agrees to fund and fees for plan documents, administration and claims substantiation. Request an itemized proposal showing setup charges, recurring fees, minimum charges and what happens to unused allowances. The total depends on the arrangement, eligible employees and reimbursement use; some types have statutory annual limits. Compare administration separately from reimbursements rather than assuming every allowance will be spent.

A group health insurance broker helps employers compare plans from multiple carriers, understand coverage and costs, enroll employees, and stay compliant with the ACA. PCI Solutions does this for Houston businesses and stays with you through every renewal.

There is no single price. Premiums depend on the plan design, the number and ages of covered employees and dependents, your employer contribution, and the carrier. We compare quotes across 70+ carriers so you can see the employer and employee share before you decide.

No. Our services are completely free for employers.

Yes. You can name PCI Solutions as your Agent of Record and keep your current plan. We take over renewals, enrollment questions and compliance support.

We handle everything from enrollment and eligibility management to premium billing and FSA/COBRA administration. You gain back valuable time and resources. Our in-depth benefits renewal analysis and market knowledge give you a strategic advantage in negotiations, securing better rates and terms.

Primary Care Insurance Solutions (PCIS) can help evaluate recruiting, onboarding, performance-management and benefits-administration tools. Start with payroll integration, employee count, reporting requirements, security needs and budget, then compare providers against the same checklist. Confirm implementation responsibilities and ongoing fees before choosing.

We conduct comprehensive audits of your benefits programs to identify and address any compliance gaps. We stay informed about new and changing regulations, ensuring your plans, documents, and processes are always up-to-date.

We offer ongoing support for ACA compliance, including reporting and calculations. We provide guidance on FMLA, plan documents, and legislative changes. We even offer medical advocacy services to help your employees navigate complex healthcare issues.

An Applicable Large Employer may owe an employer shared-responsibility payment if it fails to offer the required coverage, or if an offer is unaffordable or does not provide minimum value, and a full-time employee receives a Marketplace premium tax credit. Different payment rules apply to the different failures. Liability depends on the coverage month, workforce and applicable year; confirm the calculation with legal or tax counsel. Source: IRS, Employer shared responsibility provisions.

A wrap document supplements carrier certificates and benefit booklets with ERISA terms they may not include. It can also bring several welfare benefits under one plan document and Summary Plan Description. PCI can help gather current materials, identify changes at renewal, and coordinate document preparation with the appropriate provider.

Federal COBRA generally applies to employer group health plans when the employer had 20 or more employees on more than half of its typical business days in the prior year. Texas continuation may apply to eligible fully insured plans, including some smaller groups. Eligibility, notices, and coverage periods differ, so PCI helps coordinate the applicable process with your carrier or administrator.

A properly established Section 125 plan can let employees pay eligible health premiums before taxes. This can reduce employee taxable income and may lower the employer’s payroll tax exposure. Savings vary, and the plan requires written documents, consistent administration, and nondiscrimination testing. PCI can coordinate those steps with your payroll and plan-administration partners.

An ICHRA is an employer-funded arrangement that reimburses eligible employees for individual health insurance premiums and, if the plan allows, other qualified medical expenses. The employer sets an allowance. Employees enroll in qualifying individual coverage, provide required proof, and request reimbursement. Properly administered reimbursements are generally tax-free to employees.

Yes, but not to the same class of employees. An employer may offer a group plan to one permitted class and an ICHRA to another, such as employees in different geographic rating areas, if the design follows federal class and minimum-size rules. The classes should be reviewed before any offer is made.

An employee offered an affordable ICHRA generally cannot receive a Marketplace premium tax credit, even after opting out. If the ICHRA is unaffordable, the employee may opt out and claim a credit if otherwise eligible, but cannot also take ICHRA reimbursements for those months. Affordability should be modeled before enrollment.

Federal rules do not set a dollar cap on ICHRA allowances. The employer chooses the amount and may vary it in permitted ways, including by age or family size, if the plan is designed consistently. The practical test is whether the allowance supports the coverage goal and, when relevant, meets ACA affordability requirements.

The required notice generally goes to eligible employees at least 90 days before the plan year begins. Employees who become eligible after that should receive it no later than the date their coverage can begin. The notice describes the allowance, eligibility, opt-out rights, and how the offer may affect premium tax credits.