Free QSEHRA plan document template

Looking for a QSEHRA plan document template? You've come to the right place. The qualified small employer health reimbursement arrangement (or QSEHRA) helps small businesses afford benefits for their teams. There are two main QSEHRA plan documents that need to be written, one for the employer (Legal Agreement) and one for the employees (Plan Summary). Here are the basics!

What is a QSEHRA plan document?

A QSEHRA plan document is the documentation that you need to help you communicate the agreement between employer and employee. When it comes to the QSEHRA plan document, there are two main documents that need to be written, one for the employer (Legal Agreement) and one for the employees (Plan Summary). Take Command will walk you through both!

Getting started with QSEHRA

First things first, all you have to do as a business owner is decide the following before you begin reimbursing employees for health insurance.

• How much to reimburse - up to the contribution limits
• What to reimburse - can include premiums and eligible health expenses
• Whether to include part-time employees
• Whether or not to implement waiting periods
• When to start

2024 QSEHRA Plan Document Template

Follow this framework for a QSEHRA plan document to communicate to your employees and abide by the requirements. 

QSEHRA plan document for employers (legal agreement)

The legal agreement establishes the small business HRA for the employer. The legal agreement should include:

• Named fiduciaries and plan administrators and their responsibilities
• Eligibility requirements for the small business HRA
• Effective dates of participation
• Description of benefits provided and excluded
• How the small business HRA is funded and how it makes payments
• Claims procedures
• HIPAA privacy officers and rules relating to the use of protected health information (PHI)
• Information on federal mandates
• The procedure for amending the plan
• The procedure for plan termination

QSEHRA plan document for employees

Employees must be provided a written notice in the form of a Plan Summary. The Plan Summary is a condensed, user friendly explanation (ie- not heavy on the legal-ease) of the QSEHRA benefit and how it works.

IRS Notice 2017-67 contains guidelines on the small business HRA initial written notice contents and provides an example of written notice. The QSEHRA Employee Notice must contain the following information:

• Permitted benefit amount per employee & small business HRA start date for employee
• A statement that the eligible employee must inform any Marketplace to which the employee applies for advance payment of the premium tax credit (APTC) of the amount of the provided benefit.
• A statement that the amount of the provided benefit may affect the eligibility for and the amount of the premium tax credit and that the employee should retain the written notice because it may be necessary to calculate the premium tax credit on the employee’s individual income tax return.
• A statement that if the eligible employee does not have minimum essential coverage for any month, then the employee may be liable for an individual shared responsibility payment under Section 5000A of the Affordable Care Act for that month and that reimbursements under the small business HRA for expenses incurred in that month will be included in the employee’s gross income.

The Employee Notice can be delivered electronically according to the guidelines the IRS has set forth.

Looking for help with QSEHRA plan documents?

Does this sound confusing, expensive or both? Don't worry. That's where Take Command's HRA administrator platform can help. This post walks you step-by-step through QSEHRA administration, and just might convince you to let Take Command do the heavy-lifting and paperwork for you!

As QSEHRA administrators, we'll handle all the accounting and legal legwork, take care of onboarding each of your employees, and make tax time easy and painless. You'll never have to hassle with receipts or worry about setting up a health plan again.

This post was originally published in 2020 and has been updated with new information and insights for 2024.