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Qualified Small Employer HEAT MAP

Is a Qualified Small Employer HRA a good choice in my location?

In roughly half of the country, individual health insurance rates are lower than their small group counterparts. This means benefits dollars will stretch further in those areas with a qualified small employer HRA.

 

*2025 rates based on bronze plans for 50 year olds.
Data Courtesy of Ideon
Individual
More Expensive
Small Group
More Expensive
Small Group:
Individual:
Data courtesy of Ideon
Map graphic courtesy of MapSVG

What You Need to Know About Qualified Small Employer HRA


Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is a type of healthcare benefit that small employers can offer their employees. QSEHRA was introduced as part of the 21st Century Cures Act in December 2016. It lets employers reimburse their employees for eligible medical expenses, including health insurance premiums, up to a certain amount annually.

Before you can offer this benefit, you need to know how to set up a QSEHRA and how it works.

How QSEHRA Works


Under QSEHRA, an employer sets aside a certain amount of money each year to reimburse employees for their healthcare expenses. Money set aside for the QSEHRA can only go toward eligible medical expenses, such as health insurance premiums, deductibles, copays, and other out-of-pocket expenses. The QSEHRA allowance limit you can contribute to the plan changes annually to account for inflation and other economic factors.

QSEHRA is only available to small employers with fewer than 50 full-time employees who don't have access to group health insurance plans. Employers that offer QSEHRA cannot provide any other group health insurance plan to their employees. QSEHRA is also not available to self-employed individuals.


How to Set Up a QSEHRA


To set up a QSEHRA, you need to make a written plan document that outlines the terms and conditions of the arrangement. The plan document must include:

  • The maximum amount that the employer will contribute to QSEHRA
  • The eligibility requirements for employees
  • The eligible medical expenses that the plan will reimburse


Employers can set up a QSEHRA plan themselves (we don't actually recommend this!)  or hire a third-party administrator (TPA) to set it up and administer it on their behalf.

If you already offer group insurance plans to your employees, you need to cancel the group plan before starting the QSEHRA. Other important considerations include:

  • Employee eligibility
  • How much your budget lets you contribute to the plans
  • The type of healthcare benefits your employees prefer

 

HRA for Dummies


The acronyms and terms used in the world of employee benefits can overwhelm business owners and new HR team members unfamiliar with healthcare benefits. For example, you will likely encounter the term “HRA.” HRA stands for “Health Reimbursement Arrangement.” 

Don’t worry if that already sounds confusing. The following breaks down the basics of HRA for dummies, including the differences between QSEHRA, ICHRA, and traditional HRA plans.


HRA Defined


An HRA is an employer-funded health benefit that reimburses employees for qualified medical expenses. These expenses typically include deductibles, copays, coinsurance, and other out-of-pocket costs. HRAs are a great way for employers to give health benefits to their employees without offering a traditional group health insurance plan.


Types of HRA Plans


There are different types of HRAs available, including QSEHRA, ICHRA, and traditional HRA plans. 

QSEHRA stands for Qualified Small Employer Health Reimbursement Arrangement. It’s designed for small employers with fewer than 50 employees. 

ICHRA stands for Individual Coverage Health Reimbursement Arrangement. Employers of any size can use it to reimburse employees for their individual health insurance premiums.



Differences Between QSEHRA and ICHRA

The most obvious differences between QSEHRA and ICHRA are eligibility for participating. QSEHRAs are only for small employers. They also have annual limits. ICHRAs, in the other hand, have no limits and are for companies of any size.

Another difference between QSEHRA and ICHRA is the types of health insurance plans that employees can enroll in. 

With QSEHRA, employees must have minimum essential coverage, which means they need qualifying health insurance coverage outside of the QSEHRA. QSEHRA is more flexible on what it will reimburse compared to ICHRA.

For example, QSEHRA can reimburse for TRICARE, can work with medical sharing plans if accompanied by a MEC plan, and can reimburse for spouse's group insurance premiums. With ICHRA, employees can use the reimbursement funds to purchase individual health insurance coverage that meets the employer's requirements.

When comparing HRA vs. QSEHRA, focus on differences between the employer requirements. QSEHRA is only available to small employers with fewer than 50 employees, while any employer can offer traditional HRA plans. Additionally, with traditional HRA plans, employers can provide group health insurance coverage and an HRA. QSEHRA is only available as a standalone benefit.

HRAs can be a great way for employers to offer health benefits to their employees without providing traditional group health insurance plans. Different types of HRAs are available, including QSEHRA, ICHRA, and traditional HRA plans. Each has its unique requirements and benefits. 

By understanding the basics of HRA for dummies, employers can decide which type of HRA plan works best for the business and its employees.



What Is QSEHRA?


QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) is a type of health insurance benefit that small businesses can offer employees. QSEHRA lets small employers reimburse their employees for health insurance premiums and other medical expenses, tax-free.

To be eligible for QSEHRA, employers must have fewer than 50 full-time employees and cannot offer group health insurance coverage. Also, employers must complete a formal plan document and notify eligible employees in writing.

Employees covered under a QSEHRA must have minimum essential coverage, meaning they must have qualifying health insurance coverage outside the QSEHRA. Additionally, QSEHRA reimbursement amounts must be provided tax-free and cannot exceed the annual limit set by the IRS. (More information about annual QSEHRA contribution limits below.)

Employers are the source for funding a QSEHRA. The employers can choose how much to contribute to each employee's account each year. QSEHRA reimbursement funds can be used to cover a broad range of medical expenses, including deductibles, copays, and prescription medications in addition to insurance premiums.

Overall, QSEHRA is a strong option for small businesses that want to offer their employees health insurance benefits. However, it is important for organizations to understand the QSEHRA employer requirements and QSEHRA employee requirements before setting up a plan. A full understanding of these requirements helps ensure compliance with IRS regulations.

Do you want more information? Read our practical guide to QSEHRA for small employer benefits.



QSEHRA Limits for 2023


HRA contribution limits change annually to keep up with inflation. Cost of living adjustments set by the IRS should help employees pay for healthcare services even as those services become more expensive.

Employers and employees can contribute to QSEHRA accounts. The combined QHEHRA limit for 2023 is $3,850 for individuals and $7,750 for families. 

For comparison, 2022 QSEHRA limits were $3.650 for individuals and $7,300 for families. The amount hasn’t changed much, but it does go up each year to help people pay medical expenses.



HRA Employer Contribution Limits for 2023


Employers can contribute up to $1,950 for 2023 QSEHRA plans. That amount is $150 higher than the 2022 QSEHRA employee contribution limit ($1,800).

Employees, therefore, can contribute up to $1,900 in 2023.


QSEHRA and Premium Tax Credits

People often ask if they have a QSEHRA can they still accept premium tax credits. It's a good question and the answer is, it depends. If the reimbursement offer you receive from your employer is considered affordable (which has a technical definition), you are not allowed to accept the premium tax credits. But if the offer you receive is not considered affordable, you are allowed to take them. If you take them, you can accept money from your employer as well, but you reduce your tax credit by the amount your employer is offering. 

The government has rules about how much you are allowed to pay for your portion of your insurance premium.  While this changes each year, the safest assumption is that if your employer is offering more than your premium tax credits, you should take that offer (and ignore the tax credits). But, if the offer from your employer is less than your tax credits, take it and offset your eligible tax credit amount.

It’s important to note that you can’t opt-out of the QSEHRA and still receive your full tax credit. Your eligibility for tax credits is based on the reimbursement amount offered to you, not the amount you actually get reimbursed.

It is very important that employees purchasing a plan through the marketplace and receiving a premium tax credit adjust your tax credit accordingly. Failure to report the small business HRA to your insurer will result in having to pay back the tax credits to the IRS during tax time. 

 


QSEHRA Rules You Need to Know


Employers need to know several QSEHRA rules to comply with regulations. If you don't follow these rules, you could face fines and other penalties. You might also put your employees' healthcare benefits in jeopardy.


Who Is Eligible for QSEHRA?


It's essential to understand who is eligible for QSEHRA. QSEHRA is available to businesses with fewer than 50 full-time employees and don’t offer a group health insurance plan. Employees enrolled in a group health insurance plan or receiving subsidies through the Affordable Care Act are not eligible for QSEHRA.



QSHRA Minimum Essential Coverage


QSEHRA requires employers to give their employees minimum essential coverage. This means that employees must have access to basic health coverage that meets federal standards. 

Federal standards can change over time, so it’s a good idea to stay current with the latest updates.

If an employer fails to provide minimum essential coverage, they may be subject to penalties, including fines.


QSEHRA Plan Document


Employers must write and maintain a QSEHRA plan document. This document  outlines the terms and conditions of the QSEHRA program, including:

  • Employee eligibility
  • Reimbursement limits
  • How the program will be administered


Employers must give employees access to the QSEHRA plan document and provide copies upon request.



h2. QSEHRA Eligible Expenses in 2023


QSEHRA's eligible expenses include insurance premiums, deductibles, copays, and many medications. Of course, not every type of medical procedure is covered. For example, you can’t use funds from a QSEHRA account to pay for elective procedures like hair transplants and facelifts. However, you can use the money to pay for most acne medicines and treatments.

Other eligible expenses include:

  • Non-cosmetic dental care
  • Over-the-counter drugs
  • Eye exams
  • Fertility treatments
  • Alcohol and drug addiction treatment
  • Flu shots


Keep in mind that some HRA plans cover different expenses than others. When comparing options, don’t assume that they cover the same treatments, insurance costs, and medications.

Take Command’s QSEHRA platform makes it easier for businesses to give employees accurate information about what their plans cover. Instead of spending a lot of time reading government websites or talking to HR professionals, you can simply get the information you want from a straightforward platform designed to help you manage your employee benefits.


Learn More About How Take Command's Platform Can Help


Even when you spend time learning about QSEHRA and other HRA options, you might struggle to understand the nuances that will keep you in compliance.

Take Command's platform makes it easier than ever for you to create and manage HRA plans.