Since its creation in 2016, the qualified small employer health reimbursement arrangement (QSEHRA) has helped thousands of small businesses offer personalized health benefits to their employees.

With a QSEHRA, small businesses offer employees a monthly allowance of tax-free money. Employees buy health care products and services that fit their personal needs and submit proof of expenses to their company. The business then reimburses them up to their allowance limit.


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The QSEHRA essentially works the same everywhere, but individual states may have certain laws or market conditions that affect how the benefit operates. Additionally, businesses offer different average allowances in every state, and employee utilization rates vary.

In this guide, we’ll go over everything you need to know to successfully offer the QSEHRA in your state.

Note: Data on QSEHRA allowances and utilization was gathered from small businesses and employees using PeopleKeep software in 2017. Because not every QSEHRA employee submitted information on their family status, some allowances included in calculating overall monthly allowance averages were not included when calculating average monthly allowance averages for self-only or family employees.

Data on the condition of states’ individual markets, meanwhile, is drawn from “What Explains the 21 Percent Increase in 2017 Marketplace Premiums, and Why Do Increases Vary Across the Country?” by the Robert Wood Johnson Foundation.

QSEHRA resources

Why choose the QSEHRA

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The Comprehensive Guide

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National QSEHRA conditions

Congress created the QSEHRA in December 2016 through the 21st Century Cures Act. Written into the Internal Revenue Code and subject to federal health care laws like the Employee Retirement Income Security Act of 1974 (ERISA), the QSEHRA is legally compliant in every state.

Here’s how it works:

  1. Businesses set a monthly allowance. This per-employee allowance of tax-free money is made available for every full-time employee. There are no minimum contribution requirements, and businesses can offer different allowance amounts to employees based on whether they’re single or have a family. In 2017, businesses could offer up to $412.50 for self-only employees and $833.33 for family employees. The 2018 limits are higher, at $420.83 for self-only employees and $854.16 a month for family employees.
  2. Employees make purchases. Employees buy the products and services that fit their personal needs. There are numerous health care expenses eligible for reimbursement through the QSEHRA, including individual health insurance premiums, individual dental or vision premiums, copays, deductibles, and prescription and nonprescription drugs.
  3. Employees submit proof of expenses. After incurring an expense, employees submit proof to their company through documents like invoices, receipts, or an explanation of benefits from the employee’s insurance company.
  4. Businesses review and reimburse employees’ expenses. The business reviews employees’ documentation and, if the expense is qualified, reimburses the employee from their monthly allowance. These reimbursements are free of payroll tax for both the business and its employees and free of income tax for employees who have minimum essential coverage (MEC).

In 2017, small businesses using a QSEHRA offered an average $387 per employee per month. By family status, they offered $280 per month to self-only employees and $477 per month to employees with a family.

Though not everyone eligible for a QSEHRA used it, those who did collected an average of 77 percent of their total allowance (79 percent for self-only employees and 77 percent for employees with a family).

In the national market for individual insurance policies, the average 2017 premium for the second-lowest-cost silver plan for a single person was $342—an increase of more than 21 percent since 2016, and outstripping the average QSEHRA allowance for self-only employees by nearly $60.

Perhaps unsurprisingly, premium costs claimed the majority (84 percent) of employees’ QSEHRA allowances. In fact, 61 percent of employees who submitted a premium for reimbursement used their entire allowance on it.

Now, we’ll review similar conditions specific to each state and the District of Columbia, including:

  • State laws, regulations, and guidance affecting the QSEHRA
  • QSEHRA allowances and utilization rates in the state
  • Individual market conditions in the state

The QSEHRA by state

The QSEHRA in Alabama

State laws, regulation, and guidance affecting the QSEHRA

The Alabama legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Alabama offered an average $474 per employee per month: $275 for self-only employees, and $236 for employees with a family.

Alabama’s average allowance was 20 percent higher than the national average. The state’s allowances for self-only and family employees were 2 and 14 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Alabama collected an average of 79 percent of their total allowance (99 percent among self-only employees and 69 percent among employees with a family).

Roughly 55 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Alabama market, there are two health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Alabama
  • Bright Health

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $435—an increase of more than 51 percent since 2016. This premium cost exceeds Alabama’s average QSEHRA allowance for self-only employees by nearly $160.

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Alaska

State laws, regulation, and guidance affecting the QSEHRA

The Alaska legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Alaska offered an average $406 per employee per month: $338 for self-only employees, and $452 for employees with a family.

Alaska’s average allowance was 5 percent higher than the national average. The state’s allowances for self-only and family employees were 19 percent higher and 5 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Alaska collected an average of 67 percent of their total allowance (57 percent among self-only employees and 74 percent among employees with a family).

Roughly 50 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Alaska market, there is just one health insurance company offering individual policies on the exchange: Premera.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $901—an increase of more than 30 percent since 2016. This premium cost exceeds Alaska’s average QSEHRA allowance for self-only employees by more than $560.

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Arizona

State laws, regulation, and guidance affecting the QSEHRA

The Arizona legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Arizona offered an average $478 per employee per month: $288 for self-only employees, and $563 for employees with a family.

Arizona’s average allowance was 21 percent higher than the national average. The state’s allowances for self-only and family employees were 3 and 17 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Arizona collected an average of 60 percent of their total allowance (71 percent among self-only employees and 53 percent among employees with a family).

Roughly 44 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Arizona market, there are two health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Arizona
  • Ambetter by Health Net

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $497—a 125 percent increase since 2016. This premium cost exceeds Arizona’s average QSEHRA allowance for self-only employees by more than $200.

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Arkansas

State laws, regulation, and guidance affecting the QSEHRA

The Arkansas legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Arkansas offered an average $222 per employee per month: $200 for self-only employees, and $236 for employees with a family.

Arkansas’s average allowance was 54 percent lower than the national average. The state’s allowances for self-only and family employees were 33 and 67 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Arkansas collected an average of 81 percent of their total allowance (81 percent among employees with a family). There is insufficient data to give average utilization rates among self-only employees for 2017.

Individual market conditions

In the Arkansas market, there are three insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Arkansas
  • Centene/Ambetter (formerly Celtic)
  • QualChoice

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $281—a 4 percent decrease since 2016. This premium cost exceeds Arkansas’s average QSEHRA allowance for self-only employees by more than $80.

The QSEHRA in California

State laws, regulation, and guidance affecting the QSEHRA

California legislature and state departments haven’t issued any guidance or passed any legislation directly relating to the QSEHRA.

However, California businesses should know that although the state includes businesses with between 50 and 100 employees in its small group market, businesses with more than 49 employees aren’t eligible for the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in California offered an average $394 per employee per month: $299 for self-only employees, and $468 for employees with a family.

California’s average allowance was comparable with national averages—just 2 percent higher. The state’s allowances for self-only and family employees were 7 percent higher and 2 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in California collected an average of 80 percent of their total allowance (82 percent among self-only employees and 79 percent among employees with a family).

Roughly 44 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the California market, there are 11 health insurance companies offering individual policies on the exchange:

  • Anthem Blue Cross of California
  • Blue Shield of California
  • Chinese Community Health Plan
  • Health Net
  • Kaiser Permanente
  • L.A. Care Health Plan
  • Molina Healthcare
  • Oscar Health Plan of California
  • Sharp Health Plan
  • Valley Health Plan
  • Western Health Advantage

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $317—a 7 percent increase since 2016. This premium cost exceeds California’s average QSEHRA allowance for self-only employees by just $18.

The QSEHRA in Colorado

State laws, regulation, and guidance affecting the QSEHRA

The Colorado legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Colorado offered an average $315 per employee per month: $218 for self-only employees, and $379 for employees with a family.

Colorado’s average allowance was 20 percent lower than the national average. The state’s allowances for self-only and family employees were 25 and 23 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Colorado collected an average of 81 percent of their total allowance (91 percent among self-only employees and 75 percent among employees with a family).

Roughly 51 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Colorado market, there are seven health insurance companies offering individual policies on the exchange:

  • Anthem (HMO Colorado)
  • Bright Health Insurance
  • Cigna Health and Life Insurance
  • Friday Health Plans (formerly Colorado Choice)
  • Denver Health Medical Plan
  • Kaiser Foundation Health Plan of Colorado
  • Rocky Mountain Health Maintenance Organization

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $317—an increase of 11 percent since 2016. This premium cost exceeds Colorado’s average QSEHRA allowance for self-only employees by nearly $100.  

The QSEHRA in Connecticut

State laws, regulation, and guidance affecting the QSEHRA

The Connecticut legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Connecticut offered an average $683 per employee per month: $412.50 for self-only employees, and $827 for employees with a family.

Connecticut’s average allowance was 49 percent higher than the national average. The state’s allowances for self-only and family employees were 38 and 54 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Connecticut collected an average of 93 percent of their total allowance (89 percent among self-only employees and 100 percent among employees with a family).

Roughly 75 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Connecticut market, there are two health insurance companies offering individual policies on the exchange:

  • Anthem
  • ConnectiCare

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $436—a 24 percent increase since 2016. This premium cost exceeds Connecticut’s average QSEHRA allowance for self-only employees by just $14.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Delaware

State laws, regulation, and guidance affecting the QSEHRA

The Delaware legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Delaware offered an average $564 per employee per month: $406 for self-only employees, and $617 for employees with a family.

Delaware’s average allowance was 37 percent higher than the national average. The state’s allowances for self-only and family employees were 37 and 26 percent higher, respectively.

There is insufficient data to give average utilization rates among QSEHRA-eligible employees in Delaware for 2017.

Individual market conditions

In the Delaware market, there is just one health insurance company offering individual policies on the exchange: Highmark BCBS of Delaware.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $423—a 19 percent increase since 2016. This premium cost exceeds Delaware’s average QSEHRA allowance for self-only employees by just $17.

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in the District of Columbia

State laws, regulation, and guidance affecting the QSEHRA

The District of Columbia hasn’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in the District of Columbia offered an average $432 per employee per month: $350 for self-only employees, and $526 for employees with a family.

D.C.’s average allowance was 11 percent higher than the national average. The city’s allowances for self-only and family employees were 22 and 10 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in D.C. collected an average of 100 percent of their total allowance, both among self-only and family employees.

Roughly 67 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the D.C. market, there are two health insurance companies offering individual policies on the exchange:

  • Anthem
  • ConnectiCare

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $298—a 19 percent increase since 2016. D.C.’s average QSEHRA allowance for self-only employees exceeds this premium cost by more than $50.

The QSEHRA in Florida

State laws, regulation, and guidance affecting the QSEHRA       

The Florida legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Florida offered an average $387 per employee per month: $307 for self-only employees, and $432 for employees with a family.

Florida’s average allowance matches the national average almost exactly. The state’s allowances for self-only and family employees were 9 percent higher and 10 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Florida collected an average of 83 percent of their total allowance (85 percent among self-only employees and 82 percent among employees with a family).

Roughly 65 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Florida market, there are six health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Florida
  • Florida Blue HMO
  • Florida Health Care Plan Inc.
  • Ambetter (formerly Celtic)
  • Molina
  • Health First Health Plans

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $323—a 14 percent increase since 2016. This premium cost exceeds Florida’s average QSEHRA allowance for self-only employees by just $16.

The QSEHRA in Georgia

State laws, regulation, and guidance affecting the QSEHRA

The Georgia legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Georgia offered an average $382.68 per employee per month: $266 for self-only employees, and $450 for employees with a family.

Georgia’s average allowance matches the national average almost exactly. The state’s allowances for self-only and family employees were 5 and 6 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Georgia collected an average of 75 percent of their total allowance (75 percent among self-only employees and 76 percent among employees with a family).

Roughly 39 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Georgia market, there are four health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Georgia
  • Alliant
  • Kaiser Permanente
  • Ambetter

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $312—an 11 percent increase since 2016. This premium cost exceeds Georgia’s average QSEHRA allowance for self-only employees by more than $45.

The QSEHRA in Hawaii

State laws, regulation, and guidance affecting the QSEHRA

The Hawaii legislature and state departments haven’t issued any guidance or passed any legislation directly relating to the QSEHRA.

However, Hawaii businesses should know that although the state includes businesses with 50 employees in its small group market, businesses with more than 49 employees aren’t eligible for the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Hawaii offered an average $400 per employee per month. The average for both self-only employees and employees with a family matched the state average.

Hawaii’s average allowance was comparable to national averages—roughly 3 percent higher. The state’s allowances for self-only and family employees were 35 percent higher and 17 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Hawaii collected an average of 47 percent of their total allowance (also 47 percent among employees with a family). There is insufficient data to give average utilization rates among self-only employees in 2017.

Individual market conditions

In the Hawaii market, there are two health insurance companies offering individual policies on the exchange:

  • Kaiser Permanente
  • Hawaii Medical Service Association (HMSA)

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $325—a 25 percent increase since 2016. Hawaii’s average QSEHRA allowance exceeds this premium cost by $75.

The QSEHRA in Idaho

State laws, regulation, and guidance affecting the QSEHRA

The Idaho legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Idaho offered an average $298 per employee per month: $175 for self-only employees, and $272 for employees with a family.

Idaho’s average allowance was 26 percent lower than the national average. The state’s allowances for self-only and family employees were 46 and 55 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Idaho collected an average of 84 percent of their total allowance (100 percent among self-only employees and 82 percent among employees with a family).

 

Roughly 36 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Idaho market, there are four health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Idaho
  • Mountain Health CO-OP
  • SelectHealth
  • PacificSource

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $344—a 27 percent increase since 2016. This premium cost exceeds Idaho’s average QSEHRA allowance for self-only employees by nearly $170.

The QSEHRA in Illinois

State laws, regulation, and guidance affecting the QSEHRA

The Illinois legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Illinois offered an average $373 per employee per month: $296 for self-only employees, and $411 for employees with a family.

Illinois’s average allowance was comparable to national averages—roughly 4 percent lower. The state’s allowances for self-only and family employees were 5 percent higher and 15 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Illinois collected an average of 78 percent of their total allowance. This average utilization rate was the same among both self-only and family employees.

Roughly 49 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Illinois market, there are four health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Illinois
  • Ambetter
  • Cigna
  • Health Alliance Medical Plans (HAMP)
  • PacificSource

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $360—a 42 percent increase since 2016. This premium cost exceeds Illinois’s average QSEHRA allowance for self-only employees by nearly $65.

The QSEHRA in Indiana

State laws, regulation, and guidance affecting the QSEHRA

The Indiana legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Indiana offered an average $398 per employee per month: $285 for self-only employees, and $467 for employees with a family.

Indiana’s average allowance was comparable to national averages—roughly 3 percent higher. The state’s allowances for self-only and family employees were 2 percent higher and 2 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Indiana collected an average of 79 percent of their total allowance (100 percent for self-only employees and 78 percent for employees with a family).

Roughly 45 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Indiana market, there are two health insurance companies offering individual policies on the exchange:

  • Ambetter (formerly Celtic)
  • CareSource

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $273—roughly unchanged since 2016. Indiana’s average QSEHRA allowance for self-only employees exceeds this premium cost by just $12.  

The QSEHRA in Iowa

State laws, regulation, and guidance affecting the QSEHRA

The Iowa legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Iowa offered an average $167 per employee per month: $150 for both self-only employees and employees with a family.

Iowa’s average allowance was 79 percent lower than the national average. The state’s allowances for self-only and family employees were 61 and 104 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Iowa collected an average of 58 percent of their total allowance (100 percent for self-only employees and 15 percent for employees with a family).

Roughly 12 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Iowa market, there is just one health insurance company offering individual policies on the exchange: Medica.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $333—a 16 percent increase since 2016. This premium cost exceeds Iowa’s average QSEHRA allowance for self-only employees by more than $180.  

The QSEHRA in Kansas

State laws, regulation, and guidance affecting the QSEHRA

The Kansas legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Kansas offered an average $387 per employee per month: $217 for self-only employees, and $511 for employees with a family.

Kansas’s average allowance matches the national average almost exactly. The state’s allowances for self-only and family employees were 25 percent lower and 7 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Kansas collected an average of 72 percent of their total allowance (77 percent among self-only employees and 69 percent among employees with a family).

Roughly 47 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Kansas market, there are three health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Kansas
  • Medica
  • Centene

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $363—a 46 percent increase since 2016. This premium cost exceeds Kansas’s average QSEHRA allowance for self-only employees by nearly $150.  

The QSEHRA in Kentucky

State laws, regulation, and guidance affecting the QSEHRA

The Kentucky legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Kentucky offered an average $380 per employee per month: $300 for self-only employees, and $400 for employees with a family.

Kentucky’s average allowance is comparable to the national average—roughly 2 percent lower. The state’s allowances for self-only and family employees were 7 percent higher and 17 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Kentucky collected an average of 80 percent of their total allowance (80 percent for family employees). There is insufficient data to give average utilization rates among self-only employees for 2017.

Roughly 33 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Kentucky market, there are two health insurance companies offering individual policies on the exchange:

  • Anthem
  • CareSource

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $267—a 6 percent increase since 2016. Indiana’s average QSEHRA allowance for self-only employees exceeds this premium cost by $33.

The QSEHRA in Louisiana

State laws, regulation, and guidance affecting the QSEHRA

The Louisiana legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

There is insufficient data to give QSEHRA average allowance amounts or employee utilization rates in Louisiana for 2017.

Individual market conditions

In the Louisiana market, there are three health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Louisiana
  • HMO Louisiana
  • Vantage Health Plan

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $421—a 19 percent increase since 2016.

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Maine

State laws, regulation, and guidance affecting the QSEHRA

The Maine legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Maine offered an average $536 per employee per month: $400 for self-only employees, and $608 for employees with a family.

Maine’s average allowance was 32 percent higher than the national average. The state’s allowances for self-only and family employees were 35 and 24 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Maine collected an average of 81 percent of their total allowance (80 percent among self-only employees and 81 percent among employees with a family).

Roughly 57 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Maine market, there are two health insurance companies offering individual policies on the exchange:

  • Harvard Pilgrim
  • Community Health Options

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $378—a 20 percent increase since 2016. This premium cost exceeds Maine’s average QSEHRA allowance for self-only employees by $22.  

The QSEHRA in Maryland

State laws, regulation, and guidance affecting the QSEHRA

The Maryland legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Maryland offered an average $486 per employee per month: $330 for self-only employees, and $592 for employees with a family.

Maryland’s average allowance was 23 percent higher than the national average. The state’s allowances for self-only and family employees were 16 and 22 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Maryland collected an average of 74 percent of their total allowance (85 percent among self-only employees and 67 percent among employees with a family).

Roughly 56 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Maryland market, there are three health insurance companies offering individual policies on the exchange:

  • CareFirst
  • CareFirst Blue Choice
  • Kaiser Permanente

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $309—a 22 percent increase since 2016. This premium cost exceeds Maryland’s average QSEHRA allowance for self-only employees by $21.

The QSEHRA in Massachusetts

State laws, regulation, and guidance affecting the QSEHRA

The Massachusetts legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

However, Massachusetts’ health insurance exchange, the Massachusetts Health Connector, confirmed in a July 2017 report that it was “open to [QSEHRAs] as an additional purchasing vehicle from which small businesses may choose.”

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Massachusetts offered an average $464 per employee per month: $261 for self-only employees, and $588 for employees with a family.

Massachusetts’s average allowance was 18 percent higher than the national average. The state’s allowances for self-only and family employees were 7 percent lower and 21 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Massachusetts collected an average of 96 percent of their total allowance (100 percent among self-only employees and 96 percent among employees with a family).

Roughly 61 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Massachusetts market, there are eight health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Massachusetts
  • Harvard Pilgrim Health Care (HPHC)
  • BMC HealthNet Plan (BMCHP)
  • Fallon Community Health Plan
  • Health New England
  • Neighborhood Health Plan
  • Tufts Health Plan

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $252—a 3 percent decrease since 2016. Massachusetts’s average QSEHRA allowance for self-only employees exceeds this premium cost by just $9.  

The QSEHRA in Michigan

State laws, regulation, and guidance affecting the QSEHRA

The Michigan legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Michigan offered an average $536 per employee per month: $272 for self-only employees, and $728 for employees with a family.

Michigan’s average allowance was 32 percent higher than the national average. The state’s allowances for self-only and family employees were 3 percent lower and 42 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Michigan collected an average of 76 percent of their total allowance (90 percent among self-only employees and 73 percent among employees with a family).

Roughly 56 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Michigan market, there are eight health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Michigan
  • Blue Care Network (HMO subsidiary of BSBC Michigan)
  • McLaren Health Plan
  • Meridian
  • Molina
  • Physicians Health Plan
  • Priority Health
  • Total Health Care USA

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $266—a 6 percent increase since 2016. Michigan’s average QSEHRA allowance for self-only employees exceeds this premium cost by just $6.

The QSEHRA in Minnesota

State laws, regulation, and guidance affecting the QSEHRA

When the 21st Century Cures Act was passed, representatives from the Minnesota Departments of Insurance, Commerce, and Health issued an advisory to all health insurance companies operating in the state. The advisory clarified that the QSEHRA was acceptable in the state and urged insurers to “consider application form changes to accommodate the new QSEHRA.”

Additionally, in 2017, the Minnesota state legislature created a 30-day special enrollment period (SEP) for employees of a business that newly implements a QSEHRA.

That means that rather than waiting for the next open enrollment period, employees will be able to enroll in individual coverage immediately after their company starts offering a QSEHRA.

For existing employees, the 30-day SEP begins the day their QSEHRA benefit starts. For new hires, the SEP begins the day they start working for the company. Employees and their dependents can also start applying for individual coverage during the 30 days before the benefit starts.

Any coverage purchased during the SEP cannot start before the employee’s QSEHRA benefit begins.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Minnesota offered an average $378 per employee per month: $327 for self-only employees, and $436 for employees with a family.

Minnesota’s average allowance was comparable to the national average—roughly 2 percent lower. The state’s allowances for self-only and family employees were 15 percent higher and 9 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Minnesota collected an average of 72 percent of their total allowance (68 percent among self-only employees and 77 percent among employees with a family).

Roughly 56 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Minnesota market, there are four health insurance companies offering individual policies on the exchange:

  • Blue Plus
  • HealthPartners
  • Medica
  • UCare

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $442—a 70 percent increase since 2016. This premium cost exceeds Minnesota’s average QSEHRA allowance for self-only employees by nearly $115.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Mississippi

State laws, regulation, and guidance affecting the QSEHRA

The Mississippi legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

There is insufficient data to give QSEHRA average allowance amounts or employee utilization rates in Mississippi for 2017.

Individual market conditions

In the Mississippi market, there is just one health insurance company offering individual policies on the exchange: Ambetter.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $332—a 24 percent increase since 2016.

The QSEHRA in Missouri

State laws, regulation, and guidance affecting the QSEHRA

The Missouri legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Missouri offered an average $313 per employee per month: $256 for self-only employees, and $329 for employees with a family.

Missouri’s average allowance was 21 percent lower than the national average. The state’s allowances for self-only and family employees were 9 and 37 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Missouri collected an average of 86 percent of their total allowance (86 percent among self-only employees and 85 percent among employees with a family).

Roughly 93 percent of employees submitted at least one premium for reimbursement. 

Individual market conditions

In the Missouri market, there are three health insurance companies offering individual policies on the exchange:

  • Anthem
  • Cigna
  • Ambetter (formerly Celtic)

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $369—a 17 percent increase since 2016. This premium cost exceeds Missouri’s average QSEHRA allowance for self-only employees by more than $110.  

The QSEHRA in Montana

State laws, regulation, and guidance affecting the QSEHRA

The Montana legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Montana offered an average $532 per employee per month: $390 for self-only employees, and $729 for employees with a family.

Montana’s average allowance was 32 percent higher than the national average. The state’s allowances for self-only and family employees were 33 and 42 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Montana collected an average of 78 percent of their total allowance (100 percent among self-only employees and 74 percent among employees with a family).

 

Roughly 87 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Montana market, there are three health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Montana
  • Montana Health CO-OP
  • PacificSource

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $450—a 40 percent increase since 2016. This premium cost exceeds Montana’s average QSEHRA allowance for self-only employees by $60.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Nebraska

State laws, regulation, and guidance affecting the QSEHRA

The Nebraska legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Nebraska offered an average $471 per employee per month. Employees with a family received an average of $411. There is insufficient data to determine an average for self-only employees for 2017.

Nebraska’s average allowance was 20 percent higher than the national average. The state’s allowance for family employees was 42 percent higher.

Eligible employees who used the QSEHRA in Nebraska collected an average of 82 percent of their total allowance (47 percent for self-only employees and 100 percent for employees with a family).

Roughly 50 percent of employees submitted at least one premium for reimbursement. 

Individual market conditions

In the Nebraska market, there is just one health insurance company offering individual policies on the exchange: Medica.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $476—a 43 percent increase since 2016. This premium cost exceeds Nebraska’s average QSEHRA allowance for self-only employees by $65.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Nevada

State laws, regulation, and guidance affecting the QSEHRA

The Nevada legislature and state departments haven’t issued any guidance or passed any legislation directly relating to the QSEHRA.

However, NRS 687B.480—which took effect January 2014—allows uninsured residents to buy an individual insurance policy at any time during the year. This means Nevada employees who work for businesses offering a QSEHRA can purchase an individual policy immediately, rather than waiting for a special or open enrollment period.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Nevada offered an average $367 per employee per month: $252 for self-only employees, and $510 for employees with a family.

Nevada’s average allowance was 5 percent lower than the national average. The state’s allowances for self-only and family employees were 10 percent lower and 7 percent higher, respectively.

Eligible employees who used the QSEHRA in Nevada collected an average of 82 percent of their total allowance (78 percent for self-only employees and 86 percent for employees with a family).

Roughly 33 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Nevada market, there are two health insurance companies offering individual policies on the exchange:

  • Silver Summit
  • Health Plan of Nevada

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $314—a 7 percent increase since 2016. This premium cost exceeds Nevada’s average QSEHRA allowance for self-only employees by more than $60.  

The QSEHRA in New Hampshire

State laws, regulation, and guidance affecting the QSEHRA

The New Hampshire legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in New Hampshire offered an average $327 per employee per month: $330 for self-only employees, and $325 for employees with a family.

New Hampshire’s average allowance was 17 percent lower than the national average. The state’s allowances for self-only and family employees were 16 and 38 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in New Hampshire collected an average of 68 percent of their total allowance (52 percent among self-only employees and 100 percent among employees with a family).

Roughly 67 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the New Hampshire market, there are three health insurance companies offering individual policies on the exchange:

  • Ambetter
  • Anthem
  • Harvard Pilgrim

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $267—a 2 percent increase since 2016. New Hampshire’s average QSEHRA allowance for self-only employees exceeds this premium cost by more than $60.  

The QSEHRA in New Jersey

State laws, regulation, and guidance affecting the QSEHRA

The New Jersey legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in New Jersey offered an average $318 per employee per month: $250 for self-only employees, and $539 for employees with a family.

New Jersey’s average allowance was 20 percent lower than the national average. The state’s allowances for self-only and family employees were 11 percent lower and 12 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in New Jersey collected an average of 75 percent of their total allowance (70 percent among self-only employees and 79 percent among employees with a family).

Roughly 48 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the New Jersey market, there are three health insurance companies offering individual policies on the exchange:

  • AmeriHealth
  • Horizon BCBS
  • Oscar Health

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $339—a 4 percent increase since 2016. This premium cost exceeds New Jersey’s average QSEHRA allowance for self-only employees by nearly $90.  

The QSEHRA in New Mexico

State laws, regulation, and guidance affecting the QSEHRA

The New Mexico legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization ratesIn 2017, small businesses using a QSEHRA in New Mexico offered an average $261 per employee per month $261 for self-only employees, and $230 for employees with a family.

New Mexico’s average allowance was 39 percent lower than the national average. The state’s allowances for self-only and family employees were 7 and 70 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in New Mexico collected an average of 96 percent of their total allowance (93 percent among self-only employees and 100 percent among employees with a family).

Roughly 62 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the New Mexico market, there are four health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of New Mexico
  • New Mexico Health Connections
  • Molina
  • Christus

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $254—a 14 percent increase since 2016. New Mexico’s average QSEHRA allowance for self-only employees exceeds this premium cost by just $7.

The QSEHRA in New York

State laws, regulation, and guidance affecting the QSEHRA

The New York legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in New York offered an average $436 per employee per month $288 for self-only employees, and $584 for employees with a family.

New York’s average allowance was 12 percent higher than the national average. The state’s allowances for self-only and family employees were 3 and 20 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in New York collected an average of 77 percent of their total allowance (77 percent among self-only employees and 78 percent among employees with a family).

Roughly 50 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the New York market, there are 12 health insurance companies offering individual policies on the exchange:

  • Capital District Physicians Health Plan
  • Empire BlueCross and Empire Blue Cross Blue Shield
  • Excellus
  • Fidelis Care
  • Health Insurance Plan of Greater New York
  • Healthfirst New York
  • HealthNow New York
  • Independent Health
  • MetroPlus Health Plan
  • MVP Health Plan
  • Oscar Insurance
  • United Healthcare of New York

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $454—an 18 percent increase since 2016. This premium cost exceeds New York’s average QSEHRA allowance for self-only employees by nearly $170.   

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in North Carolina

State laws, regulation, and guidance affecting the QSEHRA

The North Carolina legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in North Carolina offered an average $414 per employee per month: $297 for self-only employees, and $492 for employees with a family.

North Carolina’s average allowance was 7 percent higher than the national average. The state’s allowances for self-only and family employees were 6 and 3 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in North Carolina collected an average of 70 percent of their total allowance (55 percent among self-only employees and 77 percent among employees with a family).

Roughly 49 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the North Carolina market, there are two health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of North Carolina
  • Cigna

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $540—a 41 percent increase since 2016. This premium cost exceeds North Carolina’s average QSEHRA allowance for self-only employees by more than $240.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in North Dakota

State laws, regulation, and guidance affecting the QSEHRA

The North Dakota legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

There is insufficient data to give QSEHRA average allowance amounts or employee utilization rates in North Dakota for 2017.

Individual market conditions

In the North Dakota market, there are two health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of North Dakota
  • Sanford

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $334—a 4 percent increase since 2016.

The QSEHRA in Ohio

State laws, regulation, and guidance affecting the QSEHRA

The Ohio legislature hasn’t passed any legislation affecting the QSEHRA, but at least one individual department has issued clarifying comments on the benefit.

In April 2017, Ohio State Auditor Dave Yost issued Bulletin 2017-002, stating that Ohio townships that don’t offer group health insurance to their employees may offer premium reimbursement through the QSEHRA if the township meets the qualifications outlined in federal law.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Ohio offered an average $344 per employee per month: $255 for self-only employees, and $413 for employees with a family.

Ohio’s average allowance was 12 percent lower than the national average. The state’s allowances for self-only and family employees were 9 and 14 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Ohio collected an average of 86 percent of their total allowance (90 percent among self-only employees and 85 percent among employees with a family).

Roughly 54 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Ohio market, there are seven health insurance companies offering individual policies on the exchange:

  • AultCare
  • Ambetter (Buckeye Community Health Plan)
  • CareSource
  • Medical Health Insuring Corp. of Ohio (Medical Mutual)
  • Molina
  • Paramount
  • Summa

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $262—a 2 percent increase since 2016. This premium cost exceeds Ohio’s average QSEHRA allowance for self-only employees by just $7.   

The QSEHRA in Oklahoma

State laws, regulation, and guidance affecting the QSEHRA

The Oklahoma legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Oklahoma offered an average $217 per employee per month: $204 for self-only employees, and $210 for employees with a family.

Oklahoma’s average allowance was 56 percent lower than the national average. The state’s allowances for self-only and family employees were 31 and 78 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Oklahoma collected an average of 76 percent of their total allowance (57 percent among self-only employees and 79 percent among employees with a family).

Roughly 25 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Oklahoma market, there is just one health insurance company offering individual policies on the exchange: Blue Cross Blue Shield of Oklahoma.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $503—a 69 percent increase since 2016. This premium cost exceeds Oklahoma’s average QSEHRA allowance for self-only employees by nearly $300.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Oregon

State laws, regulation, and guidance affecting the QSEHRA

In June 2017, the Oregon state legislature passed HB 2341.This legislation made various technical changes to better align Oregon law with federal law, including clarifications that reaffirmed the 21st Century Cures Act and explicitly allowed small businesses in the state to offer a QSEHRA.

The directors of the Oregon Health Authority and the Department of Consumer and Business Services also sent a letter to U.S. House Majority Leader Kevin McCarthy urging passage of legislation that would update HealthCare.gov to facilitate the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Oregon offered an average $313 per employee per month: $266 for self-only employees, and $318 for employees with a family.

Oregon’s average allowance was 21 percent lower than the national average. The state’s allowances for self-only and family employees were 5 and 40 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Oregon collected an average of 83 percent of their total allowance (88 percent among self-only employees and 80 percent among employees with a family).

 

Roughly 43 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Oregon market, there are five health insurance companies offering individual policies on the exchange:

  • BridgeSpan
  • Kaiser Permanente
  • Moda
  • PacificSource
  • Providence Health Plan

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $321—a 20 percent increase since 2016. This premium cost exceeds Oregon’s average QSEHRA allowance for self-only employees by $55.   

The QSEHRA in Pennsylvania

State laws, regulation, and guidance affecting the QSEHRA

The Pennsylvania legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Pennsylvania offered an average $359 per employee per month: $256 for self-only employees, and $458 for employees with a family.

Pennsylvania’s average allowance was 7 percent lower than the national average. The state’s allowances for self-only and family employees were 9 and 4 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Pennsylvania collected an average of 90 percent of their total allowance (94 percent among self-only employees and 86 percent among employees with a family).

Roughly 61 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Pennsylvania market, there are nine health insurance companies offering individual policies on the exchange:

  • Capital Advantage Assurance
  • First Priority Health
  • Geisinger Health Plan
  • Highmark, Inc. (EPO and PPO)
  • Highmark Health Insurance Company (PPO)
  • Highmark Choice Company
  • Keystone Health Plan East (Independence Blue Cross HMO)
  • QCC Insurance Company (Independence Blue Cross PPO)
  • UPMC Health Options (PPO and EPO)

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $367—a 46 percent increase since 2016. This premium cost exceeds Pennsylvania’s average QSEHRA allowance for self-only employees by more than $110.

The QSEHRA in Rhode Island

State laws, regulation, and guidance affecting the QSEHRA

The Rhode Island legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Rhode Island offered an average $520 per employee per month: $412.50 for self-only employees,  and $600 for employees with a family.

Rhode Island’s average allowance was 29 percent higher than the national average. The state’s allowances for self-only and family employees were 38 and 23 percent higher than national averages, respectively.

There is insufficient data to give average utilization rates among QSEHRA-eligible employees in Rhode Island for 2017.

Individual market conditions

In the Rhode Island market, there are two health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Rhode Island
  • Neighborhood Health Plan of Rhode Island

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $261—roughly unchanged since 2016. Rhode Island’s average QSEHRA allowance for self-only employees exceeds this premium cost by nearly $200.  

The QSEHRA in South Carolina

State laws, regulation, and guidance affecting the QSEHRA

The South Carolina legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in South Carolina offered an average $416 per employee per month: $246 for self-only employees, and $532 for employees with a family.

South Carolina’s average allowance was 7 percent higher than the national average. The state’s allowances for self-only and family employees were 13 and 11 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in South Carolina collected an average of 79 percent of their total allowance (93 percent among self-only employees and 68 percent among employees with a family).

Roughly 36 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the South Carolina market, there is just one health insurance company offering individual policies on the exchange: Blue Cross Blue Shield of South Carolina.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $390—a 29 percent increase since 2016. This premium cost exceeds South Carolina’s average QSEHRA allowance for self-only employees by nearly $145.  

The QSEHRA in South Dakota

State laws, regulation, and guidance affecting the QSEHRA

The South Dakota legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in South Dakota offered an average $833.33 per employee per month. Employees with a family were offered this average. There is insufficient data to determine an average for self-only employees for 2017.

Both the overall average allowance and family average allowance were 73 percent higher than the national average.

Eligible employees who used the QSEHRA in South Dakota collected an average 100 percent of their total allowance.

Roughly 67 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the South Dakota market, there are two health insurance companies offering individual policies on the exchange:

  • Avera
  • Sanford

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $457—a 35 percent increase since 2016.

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Tennessee

State laws, regulation, and guidance affecting the QSEHRA

The Tennessee legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Tennessee offered an average $455 per employee per month: $291 for self-only employees, and $567 for employees with a family.

Tennessee’s average allowance was 16 percent higher than the national average. The state’s allowances for self-only and family employees were 4 and 17 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Tennessee collected an average of 81 percent of their total allowance. Both self-only and family employees collected this average.

Roughly 67 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Tennessee market, there are three health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Tennessee
  • Cigna
  • Oscar Health

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $471—a 63 percent increase since 2016. This premium cost exceeds Tennessee’s average QSEHRA allowance for self-only employees by $180.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Texas

State laws, regulation, and guidance affecting the QSEHRA

In February 2018, Texas Attorney General Ken Paxton issued Opinion KP-0179 clarifying that the QSEHRA is a legal option for small businesses in the state.

The opinion was written in response to questions about Section 1501.003 of the Texas Insurance Code, which seemed to limit health reimbursement arrangements like the QSEHRA. Paxton wrote, however, that ERISA—the federal law that governs plans like the QSEHRA—has been shown in court to preempt state laws and regulations like the Texas code.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Texas offered an average $415 per employee per month: $304 for self-only employees, and $506 for employees with a family.

Texas’s average allowance was 7 percent higher than the national average. The state’s allowances for self-only and family employees were 8 and 6 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Texas collected an average of 81 percent of their total allowance (77 percent among self-only employees and 83 percent among employees with a family).

Roughly 54 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Texas market, there are eight health insurance companies offering individual policies on the exchange:

  • Ambetter (formerly Celtic)
  • Blue Cross Blue Shield of Texas
  • CHRISTUS Health
  • Community Health Choice
  • FirstCare (SHA)
  • IdealCare (Sendero)
  • Molina
  • Oscar Health

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $287—a 12 percent increase since 2016. This premium cost exceeds Texas’s average QSEHRA allowance for self-only employees by $17.  

The QSEHRA in Utah

State laws, regulation, and guidance affecting the QSEHRA

The Utah legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Utah offered an average $456 per employee per month: $262 for self-only employees, and $538 for employees with a family.

Utah’s average allowance was 16 percent higher than the national average. The state’s allowances for self-only and family employees were 7 percent lower and 12 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Utah collected an average of 84 percent of their total allowance (96 percent among self-only employees and 79 percent among employees with a family).

Roughly 59 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Utah market, there are three health insurance companies offering individual policies on the exchange:

  • Regence Blue Cross and Blue Shield
  • SelectHealth
  • University of Utah Health Plans

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $311—a 21 percent increase since 2016. This premium cost exceeds Utah’s average QSEHRA allowance for self-only employees by nearly $50.   

The QSEHRA in Vermont

State laws, regulation, and guidance affecting the QSEHRA

The Vermont legislature hasn’t passed any legislation affecting the QSEHRA, but at least one individual department has issued comments on the benefit.

In January 2018, the Vermont Legislative Joint Fiscal Office issued a brief detailing federal health care issues that had the potential to impact the state. The authors noted President Donald Trump’s October 2017 executive order advocating the expansion of health reimbursement arrangements beyond the QSEHRA, and suggested the state legislature “address … the issue proactively during the 2018 legislative session.”

No related legislation has yet been filed, however.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Vermont offered an average $469 per employee per month: $344 for self-only employees, and $569 for employees with a family.

Vermont’s average allowance was 19 percent higher than the national average. The state’s allowances for self-only and family employees were 21 and 18 percent higher than national averages, respectively.

There is insufficient data to give average utilization rates among QSEHRA-eligible employees in Vermont for 2017.

Individual market conditions

In the Vermont market, there are two health insurance companies offering individual policies on the exchange:

  • Blue Cross Blue Shield of Vermont
  • MVP Health

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $492—a 5 percent increase since 2016. This premium cost exceeds Vermont’s average QSEHRA allowance for self-only employees by nearly $150.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Virginia

State laws, regulation, and guidance affecting the QSEHRA

The Virginia legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Virginia offered an average $393 per employee per month: $271 for self-only employees, and $501 for employees with a family.

Virginia’s average allowance is comparable to the national average—roughly 2 percent higher. The state’s allowances for self-only and family employees were 3 percent lower and 5 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in Virginia collected an average of 83 percent of their total allowance (74 percent among self-only employees and 88 percent among employees with a family).

Roughly 69 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Virginia market, there are seven health insurance companies offering individual policies on the exchange:

  • CareFirst
  • Cigna
  • Group Hospitalization and Medical Services
  • Health Keepers (Anthem)
  • Kaiser Foundation Health Plan of the Mid-Atlantic
  • Optima
  • Piedmont Community Healthcare

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $319—a 9 percent increase since 2016. This premium cost exceeds Virginia’s average QSEHRA allowance for self-only employees by nearly $50.  

The QSEHRA in Washington state

State laws, regulation, and guidance affecting the QSEHRA

The Washington legislature and state departments haven’t issued any guidance or passed any legislation directly affecting the QSEHRA.

However, in March 2018, the legislature passed HB 2516, which instructed the state exchange, Washington Healthplanfinder, to “offer information to consumers and small businesses” about the QSEHRA through its website.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Washington state offered an average $381 per employee per month: $267 for self-only employees, and $441 for employees with a family.

Washington’s average allowance was comparable to the national average—roughly 1 percent lower. The state’s allowances for self-only and family employees were 5 and 8 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Washington collected an average of 80 percent of their total allowance (77 percent among self-only employees and 81 percent among employees with a family).

Roughly 65 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Washington state market, there are seven health insurance companies offering individual policies on the exchange:

  • Coordinated Care Corporation
  • Kaiser Foundation Health Plan of Washington
  • Kaiser Foundation Health Plan of the Northwest
  • Lifewise Health Plan of Washington
  • Molina Healthcare of Washington
  • Premera Blue Cross
  • BridgeSpan

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $247—roughly unchanged since 2016. Washington’s average QSEHRA allowance for self-only employees exceeds this premium cost by $20.  

The QSEHRA in West Virginia

State laws, regulation, and guidance affecting the QSEHRA

The West Virginia legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in West Virginia offered an average $648 per employee per month: $100 for self-only employees, and $737 for employees with a family.

West Virginia’s average allowance was 51 percent higher than the national average. The state’s allowances for self-only and family employees were 95 percent lower and 43 percent higher than national averages, respectively.

Eligible employees who used the QSEHRA in West Virginia collected an average of 76 percent of their total allowance (76 percent among employees with a family). There is insufficient data to give average utilization rates among self-only employees for 2017.

Roughly 50 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the West Virginia market, there are two health insurance companies offering individual policies on the exchange:

  • Highmark Blue Cross Blue Shield
  • CareSource

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $461—a 30 percent increase since 2016. This premium cost exceeds West Virginia’s average QSEHRA allowance for self-only employees by more than $360.   

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.

The QSEHRA in Wisconsin

State laws, regulation, and guidance affecting the QSEHRA

The Wisconsin legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Wisconsin offered an average $257 per employee per month: $205 for self-only employees, and $293 for employees with a family.

Wisconsin’s average allowance was 40 percent lower than the national average. The state’s allowances for self-only and family employees were 31 and 48 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Wisconsin collected an average of 74 percent of their total allowance (80 percent for self-only employees and 70 percent for employees with a family).

Roughly 50 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Wisconsin market, there are 11 health insurance companies offering individual policies on the exchange:

  • Aspirus Arise
  • Common Ground Healthcare Cooperative
  • Children’s Community Health Plan
  • Dean Health Plan
  • Group Health Cooperative of South Central Wisconsin
  • HealthPartners Insurance
  • Medica Health Plans of Wisconsin
  • MercyCare HMO
  • Network Health
  • Security Health Plan of Wisconsin
  • Unity Health Insurance

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $360—a 17 percent increase since 2016. This premium cost exceeds Wisconsin’s average QSEHRA allowance for self-only employees by $155.

The QSEHRA in Wyoming

State laws, regulation, and guidance affecting the QSEHRA

The Wyoming legislature and state departments haven’t issued any guidance or passed any legislation affecting the QSEHRA.

QSEHRA allowances and utilization rates

In 2017, small businesses using a QSEHRA in Wyoming offered an average $369 per employee per month: $370 for self-only employees, and $350 for employees with a family.

Wyoming’s average allowance was 5 percent lower than the national average. The state’s allowances for self-only and family employees were 28 percent higher and 31 percent lower than national averages, respectively.

Eligible employees who used the QSEHRA in Wyoming collected an average of 98 percent of their total allowance (100 percent for self-only employees and 96 percent for employees with a family).

Roughly 75 percent of employees submitted at least one premium for reimbursement.

Individual market conditions

In the Wyoming market, there is just one health insurance company offering individual policies on the exchange: Blue Cross Blue Shield of Wyoming.

The average 2017 premium for the second-lowest-cost silver plan for a single person in the state was $502—a 9 percent increase since 2016. This premium cost exceeds Wyoming’s average QSEHRA allowance for self-only employees by more than $130.  

It’s worth noting that this premium cost also exceeds the 2017 QSEHRA allowance cap of $412.50 for self-only employees.