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What is healthcare reimbursement?

HR • April 27, 2023 at 7:00 AM • Written by: Chase Charaba

When providing your employees with a health benefit, more options are available than just traditional group health insurance. Rather than deal with a health insurer to cover your employees’ healthcare, you can simply reimburse them for their own medical coverage and costs.

A healthcare reimbursement plan (HRP) is a benefit where employers reimburse employees for their qualifying medical expenses. This differs from traditional group health coverage because the employer makes a monetary allowance available instead of choosing and administering a group policy from a health insurer.

In this article, we’ll explain how health reimbursement plans work, which reimbursement methods are available, and how PeopleKeep can help you offer a healthcare reimbursement benefit that’s right for your organization.

New to healthcare reimbursement? Learn which type of HRA is best for you with our comparison chart

Definition of healthcare reimbursement plans

Healthcare reimbursement plans are employer-funded, tax-advantaged health benefit plans that allow business owners to reimburse employees for the cost of their medical services.

A healthcare reimbursement plan isn't health insurance. Instead, it's a way to provide allowances employees can use on their medical expenses, including monthly premiums for their own individual health insurance plans.

The term healthcare reimbursement plan has also been used to describe a type of Section 105 self-insured medical expense reimbursement plan (MERP) designed for premium reimbursement.

Why are healthcare reimbursement plans becoming popular?

Healthcare reimbursement plans are growing in popularity for a variety of reasons.

The cost of group health insurance plans is increasing year over year, making it an unaffordable option for many small to medium-sized organizations looking to offer employee benefits. For other employers, group health insurance can be a headache to manage.

While options such as high-deductible health plans (HDHPs) exist to help employers lower their benefit costs, they often leave employees with higher out-of-pocket expenses.

Health reimbursement plans are an excellent option for organizations of all sizes because they allow employees to choose the health insurance they want. With group health insurance coverage, employees may not be able to access their preferred healthcare providers or health systems because they might be out of network. With a reimbursement plan, employees can choose an individual health insurance plan that allows them to access these preferred options.

Health reimbursement plans also allow employees to choose their preferred healthcare providers and which medical expenses they want to get reimbursed, including out-of-pocket expenses. This gives employees more freedom and flexibility than other health benefits.

How healthcare reimbursement plans work

There are many different healthcare reimbursement plans available for organizations to offer. However, each type can work differently.

Many healthcare reimbursement plans are formal arrangements that require legal plan documents, while others are informal health benefits.

Formal healthcare reimbursement plan documents must comply with all applicable federal regulations and include the following details:

  • Guidance on eligibility
  • What you can reimburse employees for
  • How reimbursements are approved
  • How payments are distributed
  • What happens in the event of a decision dispute

The healthcare reimbursement process

Most health reimbursement plans allow employees to submit their medical expenses for reimbursement. Employers or third-party administrators can then approve or deny a request for reimbursement based on the plan's specific rules and regulations. Once approved, employers reimburse employees up to their monthly allowance.

What can a healthcare reimbursement account be used for?

Depending on the healthcare reimbursement option you offer, employees can use them for various healthcare costs, such as the out-of-pocket costs of medical care.

For formal health benefits such as a health reimbursement arrangement (HRA), you can only reimburse your employees for qualified medical expenses listed in IRS Publication 502. This generally excludes elective medical procedures in favor of expenses that are a medical necessity.

Health stipends can be used for virtually any medical expense, as there aren't any restrictions on eligible expenses. This can be especially helpful for mental health expenses, as an HRA only allows you to reimburse mental health-related costs if you have a diagnosed mental illness.

What are the different types of healthcare reimbursement?

Many types of reimbursement plans are available, each with pros and cons.

Health reimbursement arrangement (HRA)

HRAs are formal health benefits that allow you to reimburse your employees for qualifying medical expenses, including insurance premiums and out-of-pocket expenses.

Instead of relying on per-diem reimbursement rates, employers can set a monthly or annual allowance for employees to use. Employers then reimburse employees up to their remaining allowance.

One of the best features of an HRA is that reimbursements are tax-free for both employers and employees as long as employees have insurance with minimum essential coverage (MEC).

Three of the most popular types of HRAs are:

  • Qualified small employer HRA (QSEHRA)
    • A QSEHRA is specifically designed for organizations with fewer than 50 full-time equivalent employees (FTEs). It's an excellent option for employers who want to keep things simple and offer a single benefit to all full-time W-2 employees. Employers can specify whether they wish to provide this benefit to only full-time employees or to both full- and part-time employees.
  • Individual coverage HRA (ICHRA)
    • An ICHRA is one of the most flexible personalized health benefits. It allows employers to set different monthly allowances and determine employee eligibility based on classes. Organizations of all sizes can offer an ICHRA, and it features no monthly allowance caps. It requires an HRA notice to be sent to all eligible employees at least 90 days before the benefit is offered.
  • Group coverage HRA (GCHRA), also known as an integrated HRA
    • A GCHRA is best for employers who offer employees a traditional group health plan such as an HDHP and want to supplement their medical benefits. This helps employees with deductibles, copays, and other eligible out-of-pocket expenses.

If your organization has fewer than 50 FTEs and you don't plan on offering group health insurance, you can provide either a QSEHRA or ICHRA. However, a QSEHRA has an annual contribution limit. In 2023, the limit for self-only employees is $5,850 and $11,800 for employees with families. If you want to offer your employees a larger allowance, then an ICHRA might be better.

With a QSEHRA or an ICHRA, employees can purchase individual health insurance coverage that works best with their preferred healthcare providers, giving them more coverage options. You can then reimburse employees for their insurance premiums.

Organizations with more than 50 FTEs are considered applicable large employers (ALEs). Under the Affordable Care Act (ACA)'s employer mandate, you're required to provide health coverage that meets MEC to at least 95% of full-time employees.

Thankfully, you don't need to offer a group health plan to satisfy the mandate. An HRA helps you meet this requirement as long as you provide your employees with an allowance that meets minimum value and affordability standards.

Health stipends

You can also offer your employees a health stipend. A health stipend is an informal form of reimbursement with fewer regulations and restrictions than an HRA.

A health stipend works similarly to an HRA, where employers can set a monthly allowance for their employees. This allows employees to be reimbursed for insurance premiums so that they can choose their preferred providers and healthcare systems, as well as out-of-pocket expenses.

Because expense approval is up to the employer, you can define what’s reimbursable and what isn’t.

This greater flexibility allows organizations to offer a stipend to 1099 contractors and international workers with ease. It can also benefit organizations with employees who receive federal advance premium tax credits (APTC), as they can use their health stipend while remaining eligible for their tax credits.

However, this increased flexibility comes with a cost. Health stipends are taxable under IRS Publication 15-B1 and must be reported on your employees' W-2s as income. It also doesn’t satisfy the ACA’s employer mandate for organizations with 50 or more FTEs.

How PeopleKeep can help

The rules and regulations surrounding the healthcare industry can be tricky to navigate. If you don't want to manage your health benefit on your own, PeopleKeep can help.

As an employee benefits administration software provider, PeopleKeep allows small employers to administer benefits to their employees in minutes, leaving them with more time to focus on running their company.

When you manage your HRA through PeopleKeep, our team will perform documentation reviews, provide customer support, and generate your plan documents to ensure compliance under HIPAA and ERISA.

If a healthcare stipend is a better fit for your organization than an HRA, our WorkPerks employee stipend administration platform enables you to offer employee stipends to cover the cost of your employee's medical expenses. Additionally, you can easily add other customized stipends that cover lifestyle expenses such as wellness or remote work to your overall benefits package.


You don't need to go through a health insurance company to offer your employees a healthcare benefit. With a healthcare reimbursement plan such as an HRA, your organization can provide a cost-effective alternative to traditional group health insurance. Personalized health benefits enable your employees to have more choice in their health coverage and services, improving the quality of patient care and employee satisfaction.

Schedule a call with a PeopleKeep personalized benefits advisor now to learn how customized health benefits can work with your organization!

This blog article was originally published on February 10, 2014. It was last updated on April 27, 2023.

1. https://www.irs.gov/publications/p15b

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Chase Charaba

Chase Charaba is the content marketing manager at PeopleKeep. He started with the company as a content marketing specialist in early 2022. Chase has written more than 350 blog posts for various companies and personal projects throughout his career. He’s worked for digital marketing agencies, in-house marketing teams, and as the editor for national award-winning high school and college newspapers. He’s also a YouTuber, landscape photographer, and small business owner.