Self Funding Wrap Guidelines 

Definition of a “Wrap Plan”

A “wrap plan” includes any employer-sponsored plan, which is:
(1) Paid for or funded in whole or in part by the employer and/or the employee;

(2) Provides reimbursement for (a.) health plan deductibles, copayments, coinsurance, or medical expenses, or (b.) provides for the payment of set amounts in the event of hospitalization.

Examples include: an employer-funded flexible spending account (FSA), a health reimbursement account (HRA), self-funding or partially self funding of the deductible or other benefits, an IRS Section 105 plan, a medical expense reimbursement plan (MERP), or a hospital confinement policy. For this definition, a wrap plan does not include a health savings account (HSA) or employee-funded general purpose flexible spending account (FSA).

CARRIERS ALLOWABLE “WRAP” PLANS

Aetna

Will allow HRA’s “wrapping” and “self funding” of the deductible alongside any Aetna plan (including the HMO 70% coinsurance plan effective 7-1-11) under the following guidelines: 

• Employers can fund up to 50% of the deductible for all plans except for the HSA plans

• Employer funding a portion of the employee’s deductible, copayment/coinsurance will only be eligible for Aetna’s RAF promotion when using Aetna HealthFund HRA

• Aetna will continue to request a Statement of Understanding at new business and renewal to confirm groups are only funding a maximum of 50% of the deductible For all other Aetna MC plans, including the HRA 5000 and the MC 10,000 plans, the only funding allowed is through Aetna’s HealthFund HRA. The maximum amount of the deductible the employer can contribute is 50% 
   

Blue Shield (effective January 1, 2012) 

Allows the following plan to be wrapped:

• Simple Savings 3400/6800

There is no restriction on how much of the deductible is funded. The following guidelines apply: 

• Groups using any employer-sponsored wrap plan or product, other than an HSA or employee funded general purpose FSA, are not eligible for the RAF program.
• Groups with employees enrolling in the plan permitted to pair with a wrap product - Simple Savings 3400/6800 - are not eligible for the RAF program. This exclusion applies whether the plans are offered as standalone or as part of any package.

HealthNet (No change to guidelines)

Allows the following plans to be wrapped:

• HRA 3000
• HRA 5000

No restriction on the percentage of deductible that may be funded. Employer may apply for RAF promotion.

UHC (effective November 1, 2011)

Allows the following plans to be wrapped:

• J3-V 2000/70%
• J3-W 3000/70%

The employer may use United HealthCare or another HRA administration company. The maximum amount of the deductible the employer can contribute is 50%. RAF promotion does apply.

Sharp (No change to guidelines)

No plans at this time are HRA compatible and/or allow HRA self fund wrapping.

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