Small Business

What is a health reimbursement arrangement?

by Keely S.

A health reimbursement arrangement, or HRA for short, refers to an arrangement between employers and their employees to reimburse for medical expenses and/or insurance premiums tax-free. The purpose is for employers to help their employees afford rising healthcare costs.

What is a health reimbursement arrangement?

HRAs are built on a series of regulations to make sure they are being offered fairly and are achieving their intended aim, which is to help employees pay for benefits tax-free. The regulations also do their best to prevent the reimbursements from being used for unfair things, like executive compensation, fraud, discrimination, money laundering, etc.

Tax Code Section 105 is the regulations that cover this type of tax-friendly tool. That's why you'll hear industry folks toss around the term "Section 105 HRAs." 

Health reimbursement arrangement: what it isn’t

An HRA is not a bank account. This can be a little confusing at first, but it’s actually much simpler. Unlike Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) that are accounts, “HRA” stands for Health Reimbursement Arrangement

An HSA (aka Health Savings Account) is:

  • Funded by both employer and employee
  • Owned by Individual; employee takes funds with them when they leave
  • Employee has immediate access to money in account
  • Funds only for medical expenses that fall under the health plan’s deductible 
  • HSA funds cannot be used for insurance premiums
  • HSA participants must have a High Deductible Health Plan (HDHP) 
  • Tax benefits: tax deductible contributions, tax free reimbursements, and tax free accumulation of interest and dividends

In contrast, a health reimbursement arrangement is exactly how it sounds: the employer reimburses for premiums and medical expenses on a tax-free basis, and the employee chooses a plan that fits their needs. Employees are then reimbursed when they submit a claim. 

  • Funded entirely by Employer (no employee contributions)
  • Account owned by Employer- funds stay with employer if employee leaves company
  • Reimburses health insurance premiums and medical expenses
  • Money is reimbursed for expenses/premiums after they are incurred and receipts are provided
  • Employees must have health insurance (minimum essential coverage) to participate
  • Tax benefits: Tax free for both employee and employer

How does a health reimbursement arrangement work?

The employer chooses an HRA for her company, sets a budget that works for them, and then lets the employers know they can use it. From there, once an employee pays for a medical expense or premium, they just turn in the receipt and submit for reimbursement.

Types of health reimbursement arrangements

There are several types of HRAs that business owners can offer to their team. Our small business tax strategy HRA guide can help direct you to the best one for your business. 

  • Integrated HRAs are “integrated” with a traditional group health insurance plan and used to help reimburse out-of-pocket medical expenses not paid for by the group health plan. Typical examples would be co-pays, co-insurance, deductible payments, etc.

    • ICHRA—Available as of January 1, 2020, the individual coverage health reimbursement arrangement allows for tax-free reimbursement of benefits for any size business and for any amount.
    • EBHRA—Excepted Benefit HRAs are limited to paying for excepted benefits, like premiums for vision and dental coverage or similar benefits exempt from ACA and other legal requirements. These HRAs are only permitted if employees are offered coverage under a group health plan sponsored by the employer. Along with ICHRA, these two HRAs are the new kids on the block (and we think they are going to change the employer-sponsored benefits market in a big way!).
    • Standalone HRAs are not required to be tied to a group plan. They have a complicated history and can be even more complicated to implement based on tangled federal and state insurance regulations. A few common types that still linger around are:
    • Qualified Small Employer HRA—For businesses with less than 50 employees that do not offer a group plan, business owners can set up a QSEHRA for their team to help pay for benefits tax-free. Unlike the other standalone HRAs in this list, this small business HRA was created by the 21st Century Cures Act back in 2017 and signed into law by President Obama. We believe QSEHRA supersedes the following  standalone HRA options in about 99% of situations.
    • Spousal HRA—For employees covered by a spouse’s group plan, a Spousal HRA could reimburse medical expenses but not premiums.
    • Retiree HRA—For former employees of a firm, an employer could use a Retiree HRA to help pay for retired members’ insurance premiums and medical expenses.
    • Medicare HRA—For employers with less than 19 employees, employers could elect to reimburse a portion of an employee’s Medicare supplement premiums.

Still have questions?

Need help sorting through the details of your HRA options and finding the right one for you? Our team of experts are on hand to help. Just chat with us on our website, or check out one of our helpful guides on our favorite HRAs, like our ICHRA Guide and QSEHRA Guide. 

Picture of Keely S.

Hi, I'm Keely S.! A wife to one and mother to four, Keely does all of the things. She’s also dabbled in personal finance blogging and social media management, contributed to MetroFamily magazine, and is passionate about good food, treasure hunting and upcycling. With a B.S. in Psychology from the University of Oklahoma and a knack for a witty punchline, it’s no surprise that Keely’s social posts are as clever as they get. In her (very little) free time, you’ll find Keely with her nose in a book or trying out a local restaurant with her family.