HRA insurance defined

If you are looking for information on HRA insurance, you’ve come to the right place. HRA stands for a health reimbursement arrangement, and they are changing the way businesses offer insurance coverage to their employees. An HRA is not insurance, but these tax-advantaged tools allow employers to reimburse employees for health insurance premiums and qualified medical expenses. Let’s walk through what you need to know.

With an HRA, employees purchase their own health insurance on the open market and then submit claims to their employer to get reimbursed for the cost of their premium and if allowed, all qualified medical expenses. While there are several types of HRAs, there are currently only two types that allow employers to reimburse employees tax-free for qualified individual insurance premiums. They are:

QSEHRA – the Qualified Small Employer HRA for companies with less than 50 full-time equivalent employees
ICHRA – the Individual Coverage HRA for companies of any size with no reimbursement limits

Qualified Small Employer HRA insurance

Before an employee can participate in a QSEHRA, one must provide proof of Minimum Essential Coverage (MEC) as defined by the IRS in Section 106(g). MEC is a term that came from the Affordable Care Act.

Major medical plans: Major Medical plans are those compliant with the Affordable Care Act (ACA) and qualify as Minimum Essential Coverage. If you purchased your plan through Healthcare.gov or your state’s public marketplace, your plan is a Major Medical plan, and your reimbursement through QSEHRA will be tax-free.
Student insurance
Your spouse’s plan (only for QSEHRA – not ICHRA): If you’re covered by your spouse’s group insurance plan there are some nuances to know regarding premium reimbursement. First, only the portion of the group premium that is  not paid  for  by your spouse’s company is eligible for reimbursement. Second, most group plans are already paid on a pre-tax basis from your spouse’s paycheck. This is great! However, the IRS doesn’t want you to “double dip” and also get a pre-tax QSEHRA reimbursement, so your QSEHRA claim for your premium may be paid on a taxable basis (plan depending). If you can verify that your premium is paid post-tax by your spouse (very rare), then you can still be reimbursed tax-free through QSEHRA!
Government plans: Medicare, Medicaid, CHIP (children’s health insurance programs), Tricare, and VA Care are all eligible healthcare plans and qualify as Minimum Essential Coverage. If you are on one of these plans and pay a monthly premium out of pocket, those can be reimbursed through QSEHRA tax-free.
Dental Insurance & Vision Insurance Plans: Monthly premiums paid for individual and dental insurance plans can be reimbursed tax-free through QSEHRA. If you have dental and vision benefits through your spouse’s employer, only the portion of the group premium that is  not paid  for  by your spouse’s company is eligible for reimbursement. In addition, if your spouse pays the premiums for your dental and insurance plans pre-tax, you can only be reimbursed for these premiums on a taxable basis.
Limited Benefit Plans: Limited Benefit Plans are usually significantly cheaper than Major Medical plans but only provide a fixed amount of benefits (vs. unlimited benefits). These plans include short-term plans, fixed indemnity plans, accident plans, and any other plan that pays a medical benefit. As long as you also have a Minimum Essential Coverage health plan, and the limited benefit plan pays a medical benefit to the provider (not a cash benefit to you), the premiums on these plans can be reimbursed tax-free through QSEHRA.

This post goes into even more detail about the plans that do not meet MEC and/or are not compatible with QSEHRA.

Individual Coverage HRA insurance

The most important thing for employees to do to use a company ICHRA plan is to sign up for a qualified health plan, which basically means it provides coverage of essential benefits such as preventative and wellness services and emergency services, as well as limits on cost-sharing.

The following plans can be integrated with ICHRA.

Major medical plans purchased on the exchange (Bronze, Silver, and Gold)
Medicare (Part A+B, or Part C)
Catastrophic Plans (limited to those under age 30 or must qualify for hardship exemption)
Student Health Insurance

HRA insurance help

Need help sorting through the details of your HRA options and finding the right one for you? Our team of experts are on hand to help. Just chat with us on our website, or check out one of our helpful guides on our favorite HRAs, like our ICHRA Guide and QSEHRA Guide.