Owners establishing a health reimbursement arrangement (HRA) or a qualified small employer HRA (QSEHRA) for their employees should always include themselves and their spouses in the HRA platform, although in some cases such Owners may not receive the same amount of tax benefits as non-owner employees.
Current or former employees may participate in a HRA and receive reimbursements 100% tax-free. Employees who are also "Owners" (e.g. sole proprietors, partners, or S-Corp shareholders that own >2% of the company's shares) may use the HRA platform but may not receive the same amount of tax benefits as non-owners as explained herein.
The Owners specified above may receive reimbursement from their companies for medical expenses, and they may use the HRA platform to receive and track these reimbursements. However, reimbursements made to Owners must be reported on the owners'/partners' wages (on their W-2 and 1040 forms) subject to federal income tax withholding. These reimbursements are exempt from Federal Insurance Contributions Act (FICA) and Federal Unemployment Tax Act (FUTA) taxes, similar to profits passed through to the owner. Further, the cost of the reimbursements is a deductible expense to the business, reducing the taxable income of the business and, thus, reducing the taxable income of the owners/partners (because these are flow-through tax entities).
Note that sole proprietors and other self-employed individuals receive an above-the-line tax deduction for personal health insurance premiums. IRS Notice 2008-1 (see http://www.irs.gov/pub/irs-drop/n-08-01.pdf) clarified that S-Corp owners may only take the self-employed health insurance premium tax deduction (on Form 1040) if the S-Corp pays for or reimburses the owner for the premiums.
Owners of C-Corporations may participate in an HRA. If the company is an LLC, owner participation varies based on the way the LLC files taxes (i.e. if they file taxes as a partnership, S-Corp, or C-corp).