Everything You Should Be Aware Of the IRS’s Health Insurance Reimbursement Rules

Do you need to discover everything there is to know about the IRS health insurance reimbursement rules? We’ve got all the details you’ll need! The IRS has issued guidelines for designing and administering HRAs (health reimbursement arrangements), ensuring that they are managed fairly and without discrimination. Here are some of the essential HRA rules from the IRS.

How does health-care reimbursement work?

An HRA is a tax-advantaged benefit based on rules that guarantee it is delivered relatively and achieves its intended goal of allowing employees to pay for perks tax-free.

An HRA works almost precisely as it sounds: the company pays for premiums and medical expenses tax-free, and the employee selects a plan that meets their needs. When employees file a claim, they are repaid.

HRAs are divided into two categories that business owners should be aware of. ICHRA (individual coverage HRA), a 401(K)-style benefit solution with no company size or reimbursement limits, and QSEHRA (qualified small employer HRA), which is meant for businesses with less than 50 employees, are the two options.

ICHRA seminars on the IRS health insurance reimbursement guidelines:

  • The 11 ICHRA classes give another level of versatility. Employers can now scale benefit contributions differently depending on whether employees are hourly, salaried, or temporary workers from staffing agencies. Employers can use a variety of plan types. Still, each employee class can only have one: For example, an employer could provide full-time employees a regular group plan and part-time employees an ICHRA or QSEHRA, but not both to the same group.
  • There will be a minimum size for some categories: We understand the regulators’ goal to prevent adverse selection, but we wish the rules had been more flexible. Employers with less than 100 employees must have a “class” of at least ten employees. Group classes must make up at least 10% of the total number of employees for firms with 100 to 200 employees. Employers with more than 200 employees must have a minimum of 20 employees in each class.

Period of Special Enrollment:

Employees who are newly qualified for a QSEHRA or ICHRA will be able to enroll in an individual plan on the marketplace during a Special Enrollment Period (SEP).

Plans for Traditional Groups:

The term “traditional group plan” has been modified to exclude plans entirely comprised of “excepted benefits”: This resolves a QSEHRA issue in which employers were offering a group dental or vision plan that was rejected. Employers can now provide ICHRA and a group dental plan without any problems.

Qualified Health Plans (QHPs) are health insurance plans that meet specific criteria.

Employees must be covered by a qualified individual health plan to participate in ICHRA and receive payments. A proposal must meet two major characteristics to be declared “qualified”:

  • There are no yearly or lifetime restrictions (PHS 2711)
  • Preventive health care is covered at no cost to the patient (PHS 2713)

Plans that aren’t eligible:

ICHRA will not be available to Healthcare Sharing Ministries (HCSM): This is a disappointment. Again, we appreciate the regulators’ concerns, but healthcare sharing members currently operate outside of the risk pool.


As long as essential safeguards are followed, QSEHRA and ICHRA will not be subject to ERISA: It’s critical to maintain these plans concise and free of additional rules.

Related Articles

Back to top button