Wondering if traditional group coverage — like a plan offered through the Small Business Health Options Program (SHOP) — or a Health Reimbursement Arrangement (HRA) is right for your small business? Understanding eligibility requirements, coverage options, and costs can help you decide which option fits the needs of your small business and its employees.
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|HRAs for small employers||Individual coverage HRAs for employers of all sizes||Qualified small group plans, including SHOP|
Known as a QSEHRA, this is a specific arrangement for small employers to reimburse employees' qualifying medical expenses, like premiums for individual coverage or other expenses on a tax-free basis.
Known as an individual coverage HRA, this is an arrangement for employers of any size to reimburse employees' qualifying medical expenses, like premiums for individual coverage or Medicare on a tax-free basis.
A group health insurance plan offered by an insurance company for eligible small employers.
Defined contribution — employers select how much money to contribute to employees, up to the allowed annual limit of $5,150 for individuals and $10,450 for families (increases annually for inflation).
Defined contribution — employers select how much money to contribute to employees.
Defined benefit — employers offer a plan and in some cases are able to offer a selection of plans to their employees.
Generally, small employers with 1–50 employees (other than certain owners or their spouses) who do not offer other group health plan coverage.
Employers of any size with at least one employee (other than certain owners or their spouses).
Generally, small employers with 1–50 employees (other than certain owners or their spouses) may be eligible for SHOP coverage.
Employees can generally choose how they use a QSEHRA as long as they use it for qualifying health care expenses, and they also have minimum essential coverage, such as a plan from the Individual Marketplace.
Employees can generally choose how they use an individual coverage HRA as long as they use it for qualifying health care expenses, and have individual health insurance coverage, such as a plan from the Individual Marketplace.
Employees have a plan or selection of plans to choose from that offer minimum essential coverage, based on what the employer offers.
Employers can provide a QSEHRA at any time of the year, but must provide notice to their employees 90 days in advance. Employees with a newly provided QSEHRA will be eligible for a Special Enrollment Period in the Marketplace.
Employers can begin an individual coverage HRA at any time of the year, but must generally provide 90 days' notice to their employees prior to the start of the individual coverage HRA plan year. Employees with a new individual coverage HRA offer will be eligible for a Special Enrollment Period in the Marketplace.
Small businesses generally can enroll any time of the year.
Small employers can decide what they will contribute to their employees' health care costs, up to the annual maximum.
Employers can decide what they contribute with no annual maximum.
There is no contribution requirement for SHOP coverage, though to be eligible for the Small Business Health Care Tax Credit, employers must contribute at least 50% of the cost of premiums for all full-time employees who enroll in SHOP coverage.
QSEHRA reimbursements are not taxed to the employee; if the QSEHRA is affordable for an employee, the employee is not allowed a premium tax credit for the employee's Marketplace coverage. If the QSEHRA is unaffordable, the employee must offset any premium tax credit by the amount of the QSEHRA.
Individual coverage HRA reimbursements are not taxed to the employee; if an employee accepts the individual coverage HRA offer, no premium tax credit is allowed for the employee's Marketplace coverage. If the individual coverage HRA offer is considered affordable for an employee, the employee is not allowed a premium tax credit for the employee's Marketplace coverage.
Group health plan contributions are generally not taxed to the employee. If a qualifying employer offers SHOP coverage, the employer may be eligible for the Small Business Health Care Tax Credit.
If you currently offer group coverage, you may be able to help reimburse your employees for certain health benefits up to an annual maximum of $1,800 (adjusted annually for inflation), such as vision or dental coverage, coinsurance and copayments for individual coverage, short-term health insurance, or other health care costs. This type of HRA is not permitted to reimburse premiums for individual coverage, traditional group health plans (other than COBRA or other continuation coverage), or Medicare. See frequently asked questions about HRAs for individual coverage and excepted benefits.
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