Wondering if you can reimburse employees for medical expenses? A health reimbursement arrangement (HRA) is an employee medical reimbursement plan that allows business owners to reimburse employees for health insurance premiums and qualified medical expenses on a tax-free basis. Now there are two types of HRAs that make it possible for employers to reimburse employees for health insurance and qualified medical expenses tax-free.
Employee medical reimbursement: a history
Tax-free employee medical reimbursement used to be a common practice for small business owners. However, when the Affordable Care Act (“Obamacare”) passed in 2010, the law had the unintended consequence of disallowing tax-free reimbursement for small companies. The primary hang-up was an interpretation that any company that reimbursed for health insurance (including individual) was technically a group plan.
According to the ACA, group plans are required to provide preventive care at no cost. Since employers that reimbursed for individual plans did not meet the preventive care requirements, they would be subject to group plan penalties of up to $100 per employee per day.
While Congress addressed the hotly debated topic of "Obamacare," little was done to help fix the problem. In late 2015 the IRS started enforcing the provision and leveraging hefty fines and penalties for companies caught reimbursing for individual health insurance.
In late 2016, the bipartisan 21st Century Cures Act was signed into law by President Obama that opened up the doors for health reimbursement arrangements for small employers. Three years later, regulatory rule updates allowed for this same treatment to be used by employers of all sizes and with a greater degree of flexibility.
Today, the two new types of HRAs have emerged with exciting momentum.
ICHRAs have grown 3.5x in the past year and QSEHRAs have doubled in size on the market during that same time period, according to the HRA Council.
→ More on Employee Medical Reimbursement
→ Learn more about how an HRA is funded.
→ Check out our post on HRA account pros and cons.
How reimbursement of medical expenses works with an HRA
The mechanics of reimbursement of medical expenses with an HRA are surprisingly simple. At a high-level, employees pay for their own health expenses and employers reimburse them. Here’s how it works:
- 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
→ Read more about how health care reimbursement works here!
→ Learn more about how tax-advantaged HRAs win over medical stipends.
Employee medical reimbursement plan options
There are two types of employee medical reimbursement plans that we will cover today.
QSEHRA: a Qualified Small Employer HRA allows small employers to set aside a fixed amount of money each month that employees can use to purchase individual health insurance or use on medical expenses, tax-free. This means employers get to offer benefits in a tax-efficient manner without the hassle or headache of administering a traditional group plan and employees can choose the plan they want. The key thing to remember here is that all employees must be reimbursed at the same level. The QSEHRA is designed for employers with less than 50 employees to reimburse for premiums and medical expenses if the plan allows. There are limits on reimbursement, which you can find in this post on 2023 QSEHRA contribution limits.
ICHRA: an Individual Coverage HRA, sometimes referred to as an ICHRA plan, is a new “flavor” of HRA that allows employers of any size to reimburse any amount per month for healthcare expenses incurred by employees on a tax-free basis, starting at any time of the year. The distinguishing element of this HRA is that employees can be divided into an unlimited number of classes, like hourly vs. salary or even based on location, and be reimbursed at different levels. The ICHRA is for companies of any size. There are no limits to how much an employer can offer for reimbursement with ICHRA, which is one of the many pros when you look at ICHRA pros and cons.
→ Learn more about HRA individual health insurance options.
How can I reimburse employees for medical expenses?
To reimburse employees for medical expenses, you will need to understand how an HRA works and how easy our HRA administrator tool makes that for you.
We make it easy for employees to just snap a picture of their receipts for reimbursement. Employers have a lot of flexibility over what is reimbursed. Understanding the impact of these options can go a long way towards helping the employer achieve their objectives and keep their budget in check.
- Reimburse Insurance Premiums Only: Employers can limit reimbursements to only go towards eligible premium expenses. Typically, this refers to individual health insurance premiums but could also include eligible dental premiums, vision premiums, etc. as long as the employee has Minimum Essential Coverage (MEC) for QSEHRA or a qualified health plan for ICHRA.
- Reimburse Insurance Premiums and Medical Expenses: Most employers choose to allow medical expenses to be reimbursed too. Note: Employers can choose to exclude categories of expenses (i.e., “prescriptions”) as long as the exclusion is applied fairly to everyone.
Wondering what counts as qualified medical expenses? Here’s a comprehensive list!
Take Command, the medical reimbursement experts
For additional resources, check out our HRA Guide, QSEHRA Guide, our ICHRA Guide, or our wildly popular ICHRA FAQ Page. We are ready to chat on our website if you have any specific questions about your business and how HRAs could help. Setting up a small business HRA is simple and quick, and our team is here to help if you need it.
→ Learn how health insurance reimbursement works.
→ Learn non-negotiables HRA administrators should offer
This post was originally published in 2020 and has been updated with new information and insights for 2023.
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.