With an HRA, employers fund individual reimbursement accounts for their employees and define what those funds can be used for – i.e., specified out-of-pocket expenses such as deductibles and co-pays.

Qualified claims must be described in the HRA plan document at inception before reimbursing employees for those medical expenses. Arrangements (medical services, dental services, co-pays, coinsurance, deductibles, participation, etc.) may vary from plan to plan and an employer may have multiple plans in place, allowing much flexibility.

The employer is not required to prefund a bank account for reimbursements, instead, the employer reimburses claims as they occur.

Reimburses expenses after the primary insurance carrier has processed all charges. The primary carrier’s processing of a claim will dictate the eligible charges to be considered under the HRA reimburse as defined by the employer.

Reimburses in compliance with IRS-mandates to permit covered employees to also benefit from the tax savings utilizing the Health Savings Account (HSA).

Reimburses specified vision-related expenses. The employer specifies the services that are reimbursable as well as the frequency. The Vision HRA can be a standalone reimbursement program of vision expenses or can be integrated, reimbursing only after a fully-insured vision insurance program pays primary.

Reimburses specified dental-related expenses. The employer specifies what services are reimbursable as well as the frequency. The Dental HRA can be a standalone reimbursement program that mirrors the coverage of an existing fully-insurance plan without the associated premium cost or an integrated benefit reimbursing after a fully-insured dental insurance program pays primary.

This type of plan, although named by legislation with the HRA designation, operates differently in a number of ways than the more commonly known HRA programs.  Because the QSEHRA is not considered a group health plan, like other HRA plans are, requirements pertaining to subjects such as COBRA, ERISA and certain ACA taxes do not apply to this plan. 

First, in order to even offer this type of plan, the Employer must meet specific requirements. The Employer must be a non-ALE under ACA measurements. An Employer who is considered an ALE under the ACA measurements is not eligible to offer a QSEHRA.  Secondly, an Employer  can not offer any form of group health plan (including dental or vision plans).

If an Employer has determined they are eligible to offer the QSEHRA, they will have the option to reimburse specified qualified medical, dental, vision, IRS 213d and/or premium expenses for a defined classificaton of employees up to the designated annual limit defined by the IRS in any given year.

Reimburses specified qualified medical, dental, vision, IRS 213d or premium expenses for a defined classificaton of retired employees.

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