Tax-advantaged health reimbursement arrangements for employees

Many employers want to provide financial assistance to employees for health insurance premiums and other medical expenses in conjunction with or in place of a group health plan. Health reimbursement arrangements (HRAs) are plans sponsored by employers which provide tax-free money to employees for premiums and other medical costs. HRAs can be an important component of an employer’s benefit package for attracting and retaining employees.

This article outlines the four types of HRAs and discusses one type, integrated HRAs, in more detail. Links to our related articles that explore the other three types of HRAs are included below.

In 2013, the IRS determined that certain premium reimbursement plans, healthcare reimbursement arrangements, and other types of medical expense reimbursement plans offered by employers to help employees pay for health insurance premiums or medical expenses did not comply with the Affordable Care Act. To avoid an excise tax of $100 per affected person per day, many arrangements were terminated. Starting in 2016, Congress began enacting legislation to authorize HRAs that are not subject to the excise tax if they comply with governing rules.

Currently, there are four HRA options, but not all options are available to every employer. Therefore, employers need to understand the differences between the various HRAs.

Integrated HRAs

Eligibility

Any employer that sponsors a group health plan can offer an integrated HRA. Only employees enrolled in the employer’s group health plan (or in another group health plan such as a spouse’s employer’s plan) are permitted to participate in the integrated HRA.

Contributions

An integrated HRA is funded entirely by the employer, and the employer has discretion to determine the maximum dollar amount that it wants to contribute for a year for each employee. Because HRAs are subject to nondiscrimination rules, employers generally need to have the same contribution limit for all employees.

Employers offering HRAs typically have a group health plan with a higher deductible and use the HRA to fund all or part of that deductible. Therefore, employers set the HRA contribution limit based on the deductible of the group health plan. Because the deductible is higher, the premiums for the group health plan are lower thus saving both the employer and the employees money.

Although HRAs are account-based health plans, employers are not required to fund them through a separate plan account or trust. Instead, employers can pay employees’ medical expenses from their general assets as they are incurred and provided to the HRA for payment.

Reimbursements

In order to receive funds from an integrated HRA, an employee or the employee’s medical provider (doctor, hospital, etc.) must submit claims to the administrator of the HRA. Employers typically hire a third-party administrator to process claims and keep records of each employee’s unused account balance during the year. At the option of the employer, unused amounts in the HRA can roll over from year to year. Unused amounts cannot be paid to employees in cash.

Claims may be submitted for a wide variety of medical expenses allowable under the IRS rules. The HRA can cover expenses incurred by employees and their spouses and children under the age of 27.

ERISA

An HRA is an employer-sponsored plan subject to ERISA unless an exemption applies, such as for church or governmental plans. ERISA is a federal law that governs employee benefit plans and requires written plan documents, disclosures to plan participants, governmental filings for certain plans (Form 5500, Annual Return/Report of Employee Benefit Plan) plus other provisions.

Reporting

Employers offering an integrated HRA are required to file an annual Form 1095-B or Form 1095-C to the IRS and provide a copy to employees. In addition, they will need to file an annual Form 720, Quarterly Federal Excise Tax Return, by July 31 each year to report and pay the Patient-Centered Outcomes Research (PCOR) fee.