Top 3 Frequently Asked Questions about Qualified Small Employer Health Reimbursement Arrangements | PA Benefit Advisors

On December 13, 2016, President Obama signed the 21st Century Cures Act (Cures Act) into law. The Cures Act provides a method for certain small employers to reimburse individual health coverage premiums up to a dollar limit through HRAs called “Qualified Small Employer Health Reimbursement Arrangements” (QSE HRAs). The provision went into effect on January 1, 2017. On October 31, 2017, the IRS released Notice 2017-67, providing guidance on the implementation and administration of QSE HRAs.

Unless an employer meets all the requirements for offering a QSE HRA, previous IRS guidance prohibiting the reimbursement of individual premiums directly or indirectly, after- or pre-tax, through an HRA, a Section 125 plan, a Section 105 plan, or any other mechanism, remains in full effect. Reimbursing individual premiums in a non-compliant manner will subject an employer to a Patient Protection and Affordable Care Act (ACA) penalty of $100 a day per individual it reimburses, with the potential for other penalties based on the mechanism of the non-compliant reimbursement.

If an employer fails to meet the requirements of providing a QSE HRA, it will be subject to a penalty of $100 per day per affected person for being a non-compliant group health plan. An arrangement will be a group health plan that is not a QSE HRA if it:

  • Is not provided by an eligible employer (such as an employer that offers another group health plan to its employees).
  • Is not provided on the same terms to all eligible employees.
  • Reimburses medical expenses without first requiring proof of minimum essential coverage (MEC).
  • Provides a permitted benefit in excess of the statutory dollar limits.

An arrangement’s failure to be a QSE HRA will not cause any reimbursement of a properly substantiated medical expense that is otherwise excludable from income to be included in the employee’s income or wages. Furthermore, an arrangement designed to reimburse expenses other than medical expenses (whether or not also reimbursing medical expenses) is neither a QSE HRA nor a group health plan. Accordingly, all payments under such an arrangement are includible in the employee’s gross income and wages. An employer’s failure to timely provide a compliant written notice does not cause an arrangement to fail to be a QSE HRA, but instead results in the penalty of $50 per employee, not to exceed $2,500.

Answers to Top Three FAQs about QSE HRAs

1, Which employers may offer a QSE HRA?

Employers with fewer than 50 full-time and full-time equivalent employees (under ACA counting rules) that do not offer a group health plan. Employers that do not offer a group health plan, but offer a retiree-only plan to former employees may offer a QSE HRA.

2. Which employers may not offer a QSE HRA?

  • Employers with 50 or more full-time and full-time equivalent employees (under ACA counting rules).
  • Employers of any size that offer a group health plan, including plans that only provide excepted benefits, such as vision or dental benefits.
  • Employers that provide current employees with access to money from health reimbursement arrangements (HRAs) offered in prior years (through a carry-over).
  • Employers that offer employees access to carryover amounts in a flexible spending account (FSA).

3. What are the rules for employers in a controlled group?

  • Employers with less than 50 full-time and full-time equivalent employees (under ACA counting rules) may offer QSE HRAs, with the headcount including all employees across an entire controlled group.
  • If one employer within a controlled group offers a QSE HRA, it must be offered to all employees within the entire controlled group (or each employer must offer an identical QSE HRA).

By Danielle Capilla

Originally Published By United Benefit Advisors


Fairmount Benefits Company

Two Radnor Corporate Center
Suite 110
Radnor, PA 19087

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