To set up an ICHRA, an employer must:

  1. Determine which employees or classes will be eligible and set a budget for reimbursement amounts.
  2. Decide on which expenses will be covered (premiums only or additional medical expenses).
  3. Establish a formal plan document.
  4. Notify employees and help them understand their options.
  5. Ensure compliance with legal requirements, including affordability rules if applicable.