Is health insurance reimbursement considered income?

by Keely S.

If you have questions about health insurance reimbursement, you’re not alone. Health reimbursement arrangements (HRAs) have been around for years now but have really gained traction recently as regulatory changes gave them more accessible and more employers learn about all of the advantages they have to offer. One question we hear often is, “Is health insurance reimbursement considered income?” We'll answer that one today, but first...a refresher.

How health reimbursement works

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 and avoid the pitfalls of expensive, one-size-fits-all group plans.

The employer chooses an HRA for his or 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. The funds can be reimbursed via payroll and if the employee doesn't use all of the monthly allowance, the funds stay with the employer.

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, an HRA is simply an Arrangement. We often get asked if business owners have to pre-fund their account or send money to our account so we can distribute it to their employees. The answer is no to both questions—the money stays with the employer until an employee makes a claim that qualifies for reimbursement. If employees never make claims or don’t claim the full amount, the employer keeps it all!

Advantages of health insurance reimbursement

  • Transfers employer responsibility for health risks.
  • Transfers health decision making from employer to employee.
  • More personalized plan choices for employees. No employee is locked into a plan that might not be a good fit for them. They can also take their plan with them if they leave.
  • Simpler and more flexible plan design options.
  • Greater budget control.
  • No participation concerns.

So...is health insurance reimbursement considered income?

No. Unlike a healthcare stipend, with a health insurance reimbursement, employers don’t have to pay payroll taxes and employees don’t have to recognize income tax. In addition, reimbursements made by the company count as a tax deduction.

How to get started

Take Command Health is a recognized leader in QSEHRA administration, ICHRA administration, and small business HRA tax strategy. Is your company or client going to be a part of this exciting employer-based benefits revolution?

Chat with our team with any questions you may have about these new, tax-friendly benefits or check out our many HRA posts for more information on the background, setup process, requirements, and rules.

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.