Is a Section 105 plan right for your organization?

This guide will provide a general overview of Section 105 plans so that you can make the best benefits decisions for your organization.

Topics covered in this guide include:

• What is a Section 105 plan?
• How does a Section 105 medical reimbursement plan work?
• Benefits of Section 105 plans
• Types of Section 105 plans
• Pros of Section 105 plans
• Cons of Section 105 plans
• Design requirements
• Section 105 plan compliance
• Health reimbursement arrangements (HRAs)

What is a Section 105 plan?

A Section 105 plan is an IRS-approved health benefit that allows the tax-free reimbursement of medical and insurance expenses, as described under Section 105 of the Internal Revenue Code (IRC). 

Employers use Section 105 plans in a variety of ways. For example, a common type of Section 105 plan is a self-funded health benefit, where the employer reimburses employees for qualified health expenses rather than paying premiums to an insurance company.

How does a Section 105 medical reimbursement plan work?

Section 105 plans are simple in practice:

• The employer must establish a formally written Section 105 plan
• The employer determines a monthly or annual allowance they want to make available to each employee during a period of coverage (generally a year) and other terms of the plan

As employees submit eligible expenses, the employer reviews the expenses to verify they are eligible (this step is often outsourced to a third-party administrator or benefits administration software like PeopleKeep). The employer then reimburses the employees 100% tax-free up to the allowance cap set in the previous step.

Benefits of Section 105 plans

While there are many benefits to offering a Section 105 plan to employees, two of the primary reasons are cost savings and tax advantages.

Cost savings

Employers commonly provide a Section 105 plan for cost savings over a traditional group health insurance plan. With a self-funded health plan like a Section 105 plan, employers reimburse employees for health benefits rather than paying premiums to an insurance company.

Employers choose to self-fund their health benefits because it allows them to save the profit margin that an insurance company adds to its premium for a fully-insured plan. Plus, employers have control over their allowance amounts. This gives employers complete cost control over their benefits, avoiding yearly rate increases.

Tax advantages

With a Section 105 plan, employers and employees don't have to pay taxes on reimbursed  expenses. Many employers who don't qualify for or can't afford group health insurance often resort to offering taxable wage increases. In these cases, employers can save money by reimbursing employees through this type of plan because payroll and income taxes aren't applied. 

Organizations such as limited liability companies (LLCs), C-corporations, and partnerships can also take a full tax deduction of Section 105 plans as long as they satisfy the requirements. This includes deducting the cost of health insurance and dental insurance premiums, qualified long-term care insurance, out-of-pocket medical, dental, and vision care expenses, and other eligible expenses paid to employees.

On top of it all, a Section 105 plan doesn't have to be a standalone benefit. Employers already offering a group health plan can offer a Section 105 alongside the group plan, and there are a few ways to do that, depending on your needs.

Types of Section 105 plans

Section 105 plans can go by a few different names. Each type of plan has differences in how they're used. However, they all operate similarly, where an employer reimburses or contributes to healthcare expenses.

Types of Section 105 plans include:

• Health reimbursement arrangements (HRAs)
• Qualified small employer HRA (QSEHRA)
• Individual coverage HRA (ICHRA)
• Group coverage HRA (GCHRA), also known as an integrated HRA
• Excepted benefit HRA (EBHRA)
• Medical expense reimbursement plans (MERPs)
• Accident and health plans

Flexible spending accounts (FSAs) for eligible medical costs

Pros of Section 105 plans

When evaluating Section 105 plans, there are many advantages to offering them.

Flexibility

Section 105 plans are extremely flexible for employers. You can design the plan in various ways to meet your budget, health benefit, and hiring needs. For example, employers can decide the amount to contribute to employees' health reimbursement allowances. They can even offer different amounts to different classes of employees depending on the type of plan selected.

Employers can also choose which expenses are eligible for reimbursements, such as only insurance premiums or all eligible expenses.

For employees, Section 105 plans such as HRAs allow for personalized care. Your employees can choose their type of insurance plan and provider and only request reimbursement for the expenses that are most important to them.

Cost controls and savings

With Section 105 plans, the employer owns the funds and the plan. Section 105 reimbursements are only issued to employees once they show proof of a valid medical expense. Additionally, unused funds stay with the employer when the employee leaves an organization.

With traditional group health insurance plans, the expenses can change every year, and rate hikes are not uncommon. But with a Section 105 plan, employers set spending limits.

This gives employers complete control over the benefits spending.

Employers can also save money thanks to tax deductions. Using a Section 105 plan reduces the amount of federal insurance contribution act tax (FICA) and federal unemployment tax (FUTA) an employer pays. Employers can deduct reimbursements as a business expense and exclude them from wages subject to FUTA and the employer portion of FICA. And reimbursements are generally excluded from employees' gross income.

Recruitment and employee retention

Many organizations struggle to provide affordable health insurance. Because of their cost savings and predictability, Section 105 plans help employers offer more robust health benefits. This is a big bonus for recruiting and retaining key employees.

Additionally, the rise in healthcare consumerism has resulted in more employees seeking benefits that are personalized to their needs. With a Section 105 plan, you can accommodate the various needs of your diverse workforce.

Cons of a Section 105 plan

While Section 105 plans are excellent options for most organizations, they may not be the best option for everyone. This section will cover some potential cons to offering these plans.

These benefits may be unfamiliar

Offering a Section 105 plan is a different approach for many employers and employees. Some employers perceive the hassle and risk of fines as a con of offering a Section 105 plan.

Additionally, many employees will be unfamiliar with how these plans work compared to group health insurance, resulting in a steeper learning curve.

However, benefits administration software such as PeopleKeep can help alleviate these concerns. With our software solutions, you can set up and manage your HRA in just minutes each month. Plus, our knowledgeable team will review submitted expenses for compliance.

Limited to no tax benefits for some types of owners

Some business owners receive limited or no tax benefits from reimbursements through the business, while others can't participate directly in a Section 105 plan.

Employers can offer their employees a Section 105 plan with all organization types. However, business owner eligibility and tax benefits can differ.

C-corporations can deduct Section 105 expenses, and owner-employees are also eligible to participate. For partnerships (and LLCs filing as a partnership), you can only get coverage as a business owner through spousal employment (a spouse who is also an employee). S-corporations, however, have restrictions on taxes and owner eligibility. Sole proprietors owners are also generally ineligible for tax-free reimbursements.

Additional compliance regulations

Section 105 plans are group health plans and are subject to compliance with the IRS, ERISA, HIPAA, ACA, and other applicable federal and state rules. As such, some employers perceive compliance as a con. However, you can use a Section 105 software administrator to ensure your arrangement is compliant.

Design requirements for Section 105 plans

Here are some rules regarding Section 105 plans:

• A Section 105 plan is paid for solely by the employer and cannot be funded through employee salary deductions
• A Section 105 plan may only reimburse employees during their effective dates in the plan.
• A Section 105 plan can reimburse for eligible medical expenses and health insurance premium amounts
• Employees must substantiate each eligible healthcare expense. PeopleKeep's software helps employers perform this function, saving you time and money
• Reimbursements are generally excludable from the employee's gross income under Internal Revenue Code Sections 105 and 106
• Section 105 plans are considered group health plans and, as such, must be designed and administered to comply with the IRS, HIPAA, ERISA, COBRA, and the ACA

Section 105 plans compliance

Since Section 105 plans are considered group health plans, they must comply with IRS, HIPAA, COBRA, ERISA, and ACA rules.

IRS rules

There are a few IRS rules you need to be aware of:

• Plan documents: The IRS requires that written plan documents are established and maintained. Plan documents define what expenses are eligible for reimbursement, the amount of employer contribution, and other required details about the reimbursement plan.
• Expense documentation: The IRS requires that employees submit proper documentation verifying their claim for reimbursement and that supporting documentation is saved on file for ten years. This often takes the form of receipts and doctor's notes.
• Non-discrimination: Section 105 plans must comply with IRS nondiscrimination rules. The rules state the plan must not discriminate in favor of highly compensated individuals (HCIs) with respect to eligibility to participate in the plan or benefits provided under the plan.

Health Insurance Portability and Accountability Act (HIPAA) rules

Section 105 plans are governed by HIPAA privacy rules. To administer a plan correctly, the entity processing employee reimbursement claims receives protected health information (PHI) that is required to be held confidentially under HIPAA.

Consolidated Omnibus Budget Reconciliation Act (COBRA) rules

COBRA rules only apply to organizations with 20 or more employees. Employers must give terminated employees the option to continue their participation in the Section 105 plan for a period after termination and may charge an employee up to 102% of the value of their allowance if COBRA is elected.

Employee Retirement Income Security Act (ERISA) rules

There are a couple of ERISA rules you need to know:

• Summary plan description: Section 105 plans are employee welfare plans under ERISA. It requires every welfare plan to have a summary plan description (SPD) and to furnish copies to each participant.
• General ERISA compliance: The federal government has specific regulations employers must comply with to reimburse employees for individual health insurance premiums without triggering ERISA plan status for the individual health insurance policies. For example, the employer must not endorse specific individual health insurance policies or pay directly for them.

Affordable Care Act (ACA) rules

• Preventive care compliance: Section 2713 of the PHS Act, as added by the ACA, requires group health plans (including Section 105 plans) to cover basic preventive health services without cost-sharing.
• Dependent coverage for adult children up to age 26: Section 2714 of the PHS Act, as added by the ACA, provides that group health plans (including Section 105 plans) that make available dependent coverage of children must make such coverage available for children until 26 years of age.
• Form 720 & Patient-Center Outcomes Research Institute (PCORI) fee: The ACA includes a "research fee" that plan sponsors must pay on an annual basis annually via Form 720.
• 60-day notice of material modification: The ACA requires employers to provide 60 days of advanced notice to participants when making material modifications to their group health plan (including Section 105 plans).

Health reimbursement arrangements (HRAs)

One of the most common types of Section 105 plans is the HRA. These are sometimes referred to as health reimbursement plans, health reimbursement accounts, and reimbursement health plans. With an HRA, you can reimburse your employees for their medical care expenses, such as individual health insurance premiums and out-of-pocket expenses.

Choosing the right HRA for your organization can be complicated, so we've broken it down with our HRA comparison chart.

HRA comparison chart

Frequently Asked Questions