A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA): Empowering Small Businesses and Employees

In recent years, the landscape of employer-sponsored healthcare benefits has evolved dramatically, particularly for small businesses. With rising healthcare costs and the ever-changing regulatory environment, these businesses have sought innovative solutions to offer competitive benefits to their employees without straining their financial resources. One such solution that has gained traction is the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA), a flexible and cost-effective option that benefits both employers and employees. In this blog post, we will delve into the intricacies of QSEHRAs, exploring what they are, how they work, and the advantages they bring to the table.

Understanding QSEHRA

A QSEHRA is a type of health reimbursement arrangement that allows small employers to reimburse their employees for qualified medical expenses and health insurance premiums. It was established through the 21st Century Cures Act, signed into law in December 2016. QSEHRAs provide an alternative to traditional group health insurance plans and are specifically designed to cater to the needs of small businesses that may not have the resources to offer comprehensive health insurance coverage.

How QSEHRA Works

QSEHRAs operate as a reimbursement arrangement, where employers allocate a predetermined amount of money to each eligible employee. These funds can be used by employees to cover a wide range of medical expenses, including health insurance premiums, deductibles, co-pays, and qualified out-of-pocket medical costs. Importantly, QSEHRA contributions are made on a tax-free basis for both employers and employees, making them a cost-efficient solution.

Employers have the flexibility to set different contribution amounts for different tiers of employees, such as individual employees, employees with families, and so on. However, there is a maximum annual contribution limit set by the IRS, which is adjusted annually to account for inflation. Employees are required to have minimum essential coverage (such as an individual health insurance plan) to be eligible for QSEHRA benefits.

Advantages for Employers

For small employers, QSEHRAs offer several significant advantages:

  1. Cost Control: Unlike traditional group health insurance plans, where employers typically pay a fixed premium regardless of how much employees utilize the coverage, QSEHRAs offer cost predictability. Employers set the reimbursement limits, allowing them to control their healthcare benefit expenses.
  2. Tax Benefits: QSEHRA contributions are tax-deductible for employers and tax-exempt for employees. This tax advantage provides a substantial incentive for businesses to adopt QSEHRAs.
  3. Flexibility: QSEHRAs are customizable to the needs of the business and its employees. Employers can tailor contribution levels based on different employee categories, fostering a fair and adaptable benefits structure.

Benefits for Employees

QSEHRAs also offer numerous benefits to employees:

  1. Choice: QSEHRAs give employees the freedom to choose their preferred health insurance plans from the individual market. This empowers employees to select coverage that best aligns with their healthcare needs and those of their families.
  2. Portability: Unlike traditional group insurance plans that might be tied to employment, QSEHRA benefits remain with the employees even if they change jobs. This enhances job mobility and reduces the fear of losing healthcare coverage during transitions.
  3. Tax Savings: QSEHRA reimbursements for qualified medical expenses are not subject to income tax, providing employees with valuable tax savings.

Considerations and Compliance

While QSEHRAs offer a range of benefits, it’s essential for both employers and employees to be aware of compliance requirements and potential limitations. Employers must follow specific guidelines for setting up and administering QSEHRAs, including providing written notice to eligible employees regarding the benefit terms and conditions.

Additionally, employees need to understand the scope of qualified medical expenses and ensure that their chosen health insurance plan complies with QSEHRA regulations. The IRS provides clear guidance on what expenses can be reimbursed and the documentation required to substantiate claims.


In a rapidly changing healthcare landscape, QSEHRAs have emerged as a valuable tool for small businesses to provide competitive benefits while maintaining cost control. Their flexibility, tax advantages, and empowerment of employees make them an appealing option for both employers and their workforce. As the demand for customizable and affordable healthcare solutions continues to grow, QSEHRAs are likely to remain a prominent choice for small businesses aiming to provide quality benefits in an evolving market. As always, consulting with benefits experts and tax professionals can help navigate the intricacies of implementing and managing a QSEHRA successfully.