We love the qualified small employer health reimbursement arrangement (or QSEHRA) for its ability to help small business owners afford health insurance for their team. Employees also love this tax-advantaged HRA because they get to choose the plan that works for them, and they can take it with them when they leave.
What is a QSEHRA plan?
A QSEHRA plan, also known as a small business HRA, or a Qualified Small Employer HRA, is a relatively new benefits model that allows small businesses with less than 50 full time equivalent employees to reimburse for health insurance premiums and medical expenses tax-free.
How do QSEHRA plans work?
This is a super simple process.
- Employers design their plan and set reimbursement allowances.
- Employees pay for their own health insurance and medical bills.
- Employees provide proof of their expenses.
- Employers reimburse the employee up to the set limit.
What are the benefits of QSEHRA plans?
- Tax-free reimbursements
- Cost control and budget predictability
- Personalized plan choice for employees
- Recruitment and retention for small businesses
We could go on...
→ Read this QSEHRA review of Take Command from an IT consultant!
How do you set up a QSEHRA plan?
To get set up a QSEHRA plan, all you have to do is decide:
- How much to reimburse each month
- What to reimburse (premiums, qualified medical expenses, spouse plan premiums)
- Whether to include part-time employees
- Whether or not to implement waiting periods
- When to start offering your QSEHRA
80% of our small business clients are net new to benefits, meaning their employees are receiving employer help with health insurance for the first time.
What types of insurance integrate with QSEHRA plans?
A key part of being reimbursed for health costs tax-free is choosing a QSEHRA plan that plays by the rules.
There are several requirements for a plan to be considered MEC including coverage of the 10 essential health benefits (such as preventative and wellness services, immunizations, maternity, mental health, etc.) and limits on cost sharing (copays, deductibles, and out of pocket maximum).
Here's a list of which insurance plans make the cut and which ones don't.
- Major medical plans: Major Medical plans are those compliant with the Affordable Care Act (ACA) and qualify as Minimum Essential Coverage. If you purchased your plan through Healthcare.gov or your state’s public marketplace, your plan is a Major Medical plan, and your reimbursement through QSEHRA will be tax-free.
- Student insurance
- Your spouse’s plan (varies by QSEHRA plan): If you’re covered by your spouse’s group insurance plan there are some nuances to know regarding premium reimbursement. First, only the portion of the group premium that is not paid for by your spouse’s company is eligible for reimbursement. Second, most group plans are already paid on a pre-tax basis from your spouse’s paycheck. This is great! However, the IRS doesn’t want you to “double dip” and also get a pre-tax QSEHRA reimbursement, so your QSEHRA claim for your premium may be paid on a taxable basis (plan depending). If you can verify that your premium is paid post-tax by your spouse (very rare), then you can still be reimbursed tax-free through QSEHRA!
- Government plans: Medicare, Medicaid, CHIP (children's health insurance programs), Tricare, and VA Care are all eligible healthcare plans and qualify as Minimum Essential Coverage. If you are on one of these plans and pay a monthly premium out of pocket, those can be reimbursed through QSEHRA tax-free.
- Dental Insurance & Vision Insurance Plans: Monthly premiums paid for individual and dental insurance plans can be reimbursed tax-free through QSEHRA. If you have dental and vision benefits through your spouse’s employer, only the portion of the group premium that is not paid for by your spouse’s company is eligible for reimbursement. In addition, if your spouse pays the premiums for your dental and insurance plans pre-tax, you can only be reimbursed for these premiums on a taxable basis.
- Limited Benefit Plans: Limited Benefit Plans are usually significantly cheaper than Major Medical plans but only provide a fixed amount of benefits (vs. unlimited benefits). These plans include short-term plans, fixed indemnity plans, accident plans, and any other plan that pays a medical benefit. As long as you also have a Minimum Essential Coverage health plan, and the limited benefit plan pays a medical benefit to the provider (not a cash benefit to you), the premiums on these plans can be reimbursed tax-free through QSEHRA.
Non-Eligible Premiums for QSEHRA plans
If you would like to use an alternative plan like a sharing ministry, short-term plan, or indemnity plan, you should know that these types of plans will not meet the MEC requirement on their own.
- Cash Benefit Plans: Cash Benefit Plans pay you cash if you’re sick or injured. These plans are sometimes called Critical Illness, Gap, or Out-of-Pocket plans. The premiums on Cash Benefit Plans are not eligible for reimbursement, because these plans by definition do not provide a medical benefit. If you have a policy that provides payments for other than medical care, you can include the premiums for the medical care part of the policy if the charge for the medical part is reasonable. The cost of the medical part must be separately stated in the insurance contract or given to you in a separate statement.
- Other Types of Insurance Plans: Additional insurance policies that do not pay a medical benefit and therefore cannot be reimbursed through QSEHRA include: Life insurance policies, policies providing payment for loss of earnings, policies for loss of life, limb, sight, etc. and auto insurance.
- Health Sharing Plans: Health Sharing Plans are not technically insurance under the Affordable Care Act, and the “premiums” you pay to be a member of a Sharing Plan, typically referred to as a “monthly share” amount or similar, are not recognized by the IRS as being actual insurance premiums under IRS Section 213(D). Therefore, the monthly share amounts cannot be reimbursed through QSEHRA. However, there is a proposed IRS update that might change that! The good news is there are options to purchase "Skinny MEC" in addition to sharing plans for yourself and your family that will allow these plans to work with QSEHRA.
Pro-tip: MEC plans (or as we call them, Skinny MEC plans) can also be a nice complement to sharing ministries, short-term, and other alternative plans by covering preventive services not typically covered by alternative plans.
This post will provide you with more details about where to buy MEC plans for QSEHRA.
"Skinny MEC" plans to pair with a sharing ministry and QSEHRA plan
Here are some Skinny MEC plans to consider if you are looking for one to work with your sharing ministry.
- SafeGuard Health offers three tiers of MEC plans, depending on how much coverage you’re looking to get from this plan. It provides some flexibility for you. In general, you may not want to pay for a lot of extra things built into the cost of the MEC, especially if you’re happy with your current plan and just need a MEC plan to get QSEHRA-compliant.
- North American Health Plans offers a preventative MEC plan called SelectMed. There are also three levels of SelectMed plans available, and you can read through the benefits in each tier on their brochure here. Heads up: This MEC plan is not available in Alaska, Hawaii, Massachusetts, and New Hampshire.
Looking for more information?
For more information, check out our comprehensive QSEHRA guide. We wrote this guide about what can be reimbursed, ensuring that you get the most benefits out of the QSEHRA. Or maybe we’ve answered your questions in our QSEHRA FAQ page.
- Our QSEHRA Administration Platform
- QSEHRA Reimbursement Guide
- QSEHRA FAQs
- QSEHRA Plan Designer Tool
- QSEHRA Tax Savings Calculator
You can also chat with our team anytime on our site or click on that beautiful green button below. We would be happy to help you.
→ Learn about what to expect from a QSEHRA provider
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.