Sept. 13, 2022

We recently revised the individual coverage health reimbursement arrangement (ICHRA) enrollment forms. Updated versions are now available on the agent Forms and Documents page.

ICHRA documents include:

• New Group Checklist
• Administrative Services Agreement (ASA)
• Employee Enrollment Form
• Enrollment Census 
• Electronic Funds Transfer (EFT) Form
• Payroll Express Form

The Administrative Services Terms and Conditions and Plan of Benefits are also available. You must include these two documents when sending the ASA to a group. 

We will no longer require the ICHRA Election Form when sending in a census. We will send a member fulfillment email to new groups to distribute to enrolled employees. This email will detail their obligations for remaining on the ICHRA account.

Please send all completed forms to Enrollment.AccrueHealth@bcbssc.com