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Here’s What You Need To Know About Qualified Small Employers Health Reimbursement Agreement (QSHERA)

The Coronavirus pandemic is transforming the business structure globally. Small business owners felt the impact quite prominently. The increasing healthcare expenditure makes it difficult for small business proprietors to deal with their employees’ health insurance needs. With the pandemic forcing small business owners and upcoming startup entrepreneurs to lay off their employees, they battle to provide group health insurance to the personnel! Thankfully, Qualified Small Employers Health Reimbursement Arrangement is there to solve all healthcare-related issues. Setting up a QSEHRA might help small-business owners like you to offset the healthcare-related expenses of your employees.


QSEHRA is a healthcare expenditure reimbursement plan that covers employees’ HealthCare costs every year. The plan has been set by the small business owners who don’t want to opt for group health insurance plans. QSHERA is not exactly a group health policy, but an alternative way to provide health coverage to the employees more cost-effectively. Small enterprise proprietors can certainly make the most out of it since it tends to fit well under lower budgets. For any individual, the maximum limit is $4,950 per year and $10,000 for family coverage. The policy applies to qualified medical expenditures.

How Does It Work?

For a business to qualify for the QSEHRA plan, it has to fulfill some strict IRS criteria. QRHERA can only be available to offer the employees once the companies can adhere to those guidelines. The first and foremost requirement is an adequate employee count. Companies must have less than fifty full-time employees to avail of the plan. Beyond fifty, the businesses can choose flexible painting arrangements (FSA). The reimbursed amounts are tax-free for employees. Internal Revenue Service sets the coverage limits, and it’s tax-free, as mentioned before.

Know The Plan And Act Accordingly

One of the best advantages of this plan is its flexibility. From the employers’ structural framework to employees’ desired plans — the flexible plans are beneficial for both employers and employees. It’s not choosing traditional HMO, HDHP, or PPO plans that employees have to accept whether they want to or not. With QSEHRA, employees get the flexibility of opting for the healthcare benefits according to their preferences. They get what they pay for. To choose a cost-effective QSEHRA for your business, you need to understand the plans thoroughly.

Design Your Policy

First, ensure your agreement plans meet the IRS guidelines or requirements. Evaluate your financial affordability and design your reimbursement policy accordingly. From flat rates to separate rates based on employees’ different criteria such as marital status, age — you can always give them options accordingly. However, make sure the smooth and fair execution of it.

Make Your Employees Choose What They Pay For

According to the listed IRS Publication 502, your team members can pay for their medical expenses, including a list of extensive services like Insurance premiums, hearing aids, emergency services, non-cosmetic surgery, and eye check-ups, etc. Set a limit for everyone for better cost-effectiveness.

Ensure Transparency

Although receiving receipts of reimbursement from employees sounds easy, there’s an exception: the HIPAA Act of 1996.  According to the act, the health information of patients must be well protected. But since patients share sensitive information for reimbursement purposes, your organization must be HIPAA compliant. To make your company a HIPAA compliant one, you need to know the government rules and regulations. To avoid penalties or fines, enlist your organization to HIPAA as soon as possible.

Set The Reimbursement Limit And Preferable Employees

The tax-free reimbursements must operate under a certain cap so that the entire model becomes financially sustainable. Do not forget to obtain the reimbursement bills and receipts to verify whether people are exceeding the limits. QSEHRA has certain pros and cons like any other healthcare policy, so do a thorough comparison between QSERHA and traditional group health coverage plans to evaluate sustainability.

While the benefits of QSEHRA is only for full-time employees, you can also include seasonal and part-time employees if you wish to! However, you cannot include contractors in this coverage.

Due to the flexible benefit plans and other added advantages, QSEHRA surely is a cost-effective option for small-business owners. However, the add-on paperwork and tax complications are some of its setbacks. But if executed properly, this can be a true beneficial option for the proprietors in the long run. Remember, before chalking out the plan, talk to a professional tax advisor for more clarity.

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