How the QSEHRA works for spouses

February 1, 2019

One advantage of the qualified small employer health reimbursement arrangement (QSEHRA) is that employee spouses can receive value from the benefit regardless of their situation.

Though spouses don’t receive their own monthly allowance amount, they can submit their personal expenses for reimbursement through the employee’s allowance. Spouses also qualify for the QSEHRA’s tax benefits as long as they’re covered under a major medical policy.

There are rules that apply to spousal reimbursement, though. In this post, we’ll explore how the QSEHRA works for spouses and how businesses, their employees, and employee spouses can stay in compliance when using the benefit. 

Which expenses can spouses have reimbursed through the QSEHRA?

Spouses are entitled to receive reimbursement for all the same expenses employees are.

However, if a spouse is enrolled in their employer’s group plan, premiums paid toward that plan cannot be reimbursed through the QSEHRA. Other expenses associated with the policy, such as copays or amounts paid toward the deductible, are eligible.

How do spouses submit QSEHRA reimbursement requests? 

Depending on how a small business administers the QSEHRA, spouses or dependents can submit their expenses for reimbursement directly or through the employee.

Participants must make sure, however, that individuals sharing the same monthly allowance don’t submit reimbursement requests for the same expense to each separate QSEHRA account. This could lead to over-reimbursement and require the couple or family to return the sum. 

How can spouses receive QSEHRA reimbursements tax-free?

Spouses are entitled to the same tax advantages as employees. As long as the spouse has minimum essential coverage (MEC), they can receive all reimbursements tax-free.

MEC may come from many sources, including the employee’s personal family health insurance policy, the spouse’s own individual insurance policy, or the spouse’s employer’s group health insurance policy.

If spouses don’t have MEC, any reimbursements made for their medical expenses will be considered taxable income to the employee.*

*Alternatives to major medical policies, such as health care sharing ministries and most short-term health policies, do not constitute minimum essential coverage. Spouses participating in these programs without MEC may not have their expenses reimbursed tax-free. 

Are there special rules for spouses who both have a QSEHRA allowance?

Married individuals who are both eligible for a QSEHRA should be cautious in how they submit reimbursement requests.

Specifically, spouses need to ensure they aren’t being reimbursed twice for the same payment. While both spouses can submit premium reimbursement requests for an expense, the total amount reimbursement shouldn’t exceed the original cost.

For example, suppose a married couple—Sean and Becky—are both eligible for separate QSEHRA allowances. Sean receives $300 from his employer and Becky receives $350. They share a family health insurance policy with a premium of $1,000 a month. In this case, both Sean and Becky can submit the premium for full reimbursement because their combined reimbursement would be $650 (less than the total cost of $1,000). If they were to switch to a policy costing $600, they would need to coordinate their reimbursement requests so they only receive $600 every month.

To do otherwise would lead to improper reimbursement. As such, it’s very important that married couples communicate with each other on how they’ll handle QSEHRA reimbursement requests. 


Spousal benefit is a significant feature of the QSEHRA.

Unlike with group health insurance, spouses can receive value from the QSEHRA regardless of their personal situation. To ensure all reimbursements are proper and tax-free, though, spouses should follow the rules outlined in this post.

How the QSEHRA works for employees
Learn how a QSEHRA can provide value to employees in any situation.
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