20 Rules for Operating a Health Reimbursement Arrangement (HRA)

Update for 2018: Please see “2018: The year for a Health Reimbursement Arrangement (HRA)

Update December 10, 2017: I published an annotated copy of IRS proposed regulations for Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) that should be followed with 2018 QSEHRAs. It makes sense to view this as an additional option and not a replacement of the traditional HRAs discussed below.

Update January 30, 2017: New Health Reimbursement Arrangements are available to qualifying small businesses.

Update December 30, 2016 – If your small business reimburses employee health care costs, you need to be aware that tax laws have changed effective July 2015 and again in December 2016 and there may be actions necessary right now to amend your reimbursement arrangement and avoid potentially severe tax liabilities as a result of the Affordable Care Act (ACA). The IRS issued a series of rules and notices from 2013 to 2016 that detail the new tax rules.

HRAs must properly incorporate primary health insurance or risk substantial tax penalty. This following expanded list of 20 items may help small business employers and their tax advisers gain a better understanding of the new excise tax rules and how to avoid them.

Please note that if you are operating a company with one participant in the health plan or where husband and wife are the only health plan participants, many of these 20 items do not apply. Please read the note at the end of the article first.

Affordable Care Act prescription bottle on blue with sethescope and pills.
The Affordable Care Act dramatically changes the tax rules for employers who reimburse employee medical expenses.


1. The federal government considers your informal employee health care payment arrangement to be subject to the extensive legal requirements of a “group health plan” (even if you did not intend it so or think of it that way). The legal requirements include exposure under the requirements of the Employee Retirement Income Security Act of 1974 for employee welfare benefit plans.

2. To avoid taxes and legal liabilities, the HRA must either be integrated with an employer-provided ACA-compliant group health insurance plan or must comply with the provisions of  Section 18001 of the 21st Century Cures Act. The latter are sometimes referred to as QSEHRAs that are not the primary focus of this article.

3. The HRA must be in writing unless you are reimbursing insurance costs only.

4. Employers who do not offer group health insurance may now reimburse the cost of individual health insurance or out-of-pocket medical expenses.

5. Where an employee is covered by their spouse’s plan, employers may not reimburse the cost of the spousal coverage.

6. The HRA may cover employees who are not covered by the employer’s group insurance plan, including the spouse or dependents who are not on the group health insurance.

7. For purposes of determining whether a violation of ACA market reforms has occurred, it does not matter whether the reimbursements were made on a pre-tax or after tax basis.

8. Taxation of health benefits to the employee is a separate issue from the applicability of excise taxes on the employer. The normal treatment is to exclude the benefit from employee income but the benefit would be taxable compensation in some cases where the employee does not maintain minimum essential coverage. This article does not cover taxation of benefits under an HRA.

9. Employers who give taxable compensation bonuses may make reference to employee health care costs if that is the purpose of the bonus arrangement.

10. The minimum statutory tax penalty for unintentional violation of ACA market reform law not modified by the 21st Century Cures Act is 10% of the amount the employer paid. The maximum amount of penalty is $100 per employee per day of violation, plus (if applicable) wage taxes plus (if applicable) interest and penalties.

11. Stand-alone HRAs may reimburse up to $4,950 for an eligible employee and $10,000 for an employee with family coverage.

12. If an employees is not covered for the entire year, the limitations are prorated.

13. A HRA must be communicated to employees separately from the insurance plan.

14. Employees may not contribute to a HRA. All contributions must be employer paid.

15. HRAs are effective in expanding coverage at a higher overall cost. HRAs are not effective in reducing the overall cost of employee health benefits. In fact HRAs may someday trigger the “Cadillac tax” provisions for rich health benefits in the future because they increase the total health benefits for employees (unless this tax s repealed as expected).

16. Improper reimbursements trigger severe excise penalties under section 4980D of the Internal Revenue Code. This penalty is $100/day excise tax per applicable employee (which is $36,500 per year, per employee). Smaller penalties may apply if the violation was not due to willful neglect. The penalties must be self-reported beginning in 2014 yet many employers may not even realize that they are in violation so the likelihood of interest and late payment penalties further compounds the problem.

17. If the employer is subject to the smaller 10% excise penalty for one year and then still does not correct the HRA plan for 2016, there would likely be a greater likelihood that the higher severe penalty would be assessed for the same repeat violation in the second year.

18. Employers that had a medical reimbursement plan prior to July 1, 2015 and have not updated their plan this year may unknowingly be subject to the excise tax. Apparently there are many small firms that don’t even know about this problem).

19. Employers affected penalties in #16 above should act as quickly as possible to terminate or amend their HRA plan and make appropriate payroll tax adjustments if necessary to avoid additional lateness tax penalties.

20. Excise tax penalties under IRC 4980D are self-reported on IRS Form 8928. The first small business penalty taxes were payable March 16, 2016 by corporate filers on violations occurring from July to December 2015. Apparently the first IRS audits of these employers subject to penalties are underway in late 2017.


The good news: For most small businesses, it is easy and inexpensive to get experienced professional help with the setup and documentation of a self-administered HRA. I’ve acted as adviser to help set up or amend these benefits for dozens of small businesses and nonprofit organizations across the U.S. since the 1980s. In many cases the work can be accomplished as a flat fee concierge advisory service. I can provide sample HRA plan documents to qualifying businesses but you may wish to have an attorney review them; I cannot provide legal services.


Disclosure and clarification

The advice in this article is simplified for the purpose of clear communication regarding most small businesses. As with most aspects of tax and benefit law, there are special circumstances that may not be addressed in this general information. This article ignores the possibility of uninsured ACA-compliant health plans or grandfathered health plans simply because these are not common.

*Many of these points do not apply to one participant health plans or small C corporations. A husband and wife C corporation might be operated as a two employee company for other purposes but the HRA could be designed as a one person health benefit plan with dependent (the other employee/spouse) coverage. Then, as a one person health plan the HRA would be exempt from classification as an employer-provided health plan as discussed in IRS Notice 2015-17 that clarifies Code § 9831(a)(2) provides that the market reforms do not apply to a group health plan that has fewer than two participants who are current employees on the first day of the plan year. Accordingly, an arrangement covering only a single employee (whether or not a shareholder-employee) generally is not subject to the market reforms whether or not such a reimbursement arrangement otherwise constitutes a group health plan. In the case, the “old rules” apply and the HRA could be operated in the same manner as before ACA. It is still important that the plan documents support the fact pattern presumed in this discussion.

The term “health insurance” in this discussion refers to primary ACA-compliant major medical insurance also known as “minimal essential coverage”.



26 U.S.C. 4980D Failure to meet certain group health plan requirements

29 CFR 2510.3-1(j) http://www.gpo.gov/fdsys/pkg/CFR-2010-title29-vol9/pdf/CFR-2010-title29-vol9-sec2510-3-1.pdf

IRS Notice 2013-54 http://www.irs.gov/pub/irs-drop/n-13-54.pdf

IRS Notice 2015-87 https://www.irs.gov/pub/irs-drop/n-15-87.pdf

IRS Notice 2016-4 https://www.irs.gov/pub/irs-drop/n-16-04.pdf

Application of Affordable Care Act Provisions to Certain Healthcare Arrangements https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/cms-hra-notice-9-16-2013.pdf

US Department of Labor, FAQs about Affordable Care Act Implementation (Part XXII) http://www.dol.gov/ebsa/faqs/faq-aca22.html

Why ACA Employer Mandate Rules Need More Guidance” by Alden Bianchi in Employee Benefit News, 12/25/2014.

TD 9705: Minimum Essential Coverage and Other Rules Regarding the Shared Responsibility Payment for Individuals, 11/26/2014  (How employer contributions to HRAs affect calculation of affordability and exemption from individual mandate penalty) https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-27998.pdf


Related topics:

The changing role of small business HRAs

Small business health plan compliance checklist

Taxation of health insurance in 2014

21st Century Cures Act


19 responses to “20 Rules for Operating a Health Reimbursement Arrangement (HRA)”

  1. An accountant pointed out that this article is not useful for small C corporations. I plan to edit it and possibly write a separate article for Health Reimbursement Arrangements in a small C corporations.

  2. […] This article was effectively replaced by http://tonynovak.com/everything-your-small-businesses-needs-to-know-about-health-reimbursement-arran…. […]

  3. […] procedure applies only to uninsured health plans like medical expense reimbursement plans (MERP), health reimbursement arrangements (HRA) and flexible spending accounts (FSA).  This does not apply to health plan expenses paid through […]

  4. Hi Tom –
    I own a small C Corp with my wife, we are both W2 employees and also employ our two young children in the summer. I want to be sure we are considered a one-person corporation so we can use an HRA to have the Corp reimburse our out-of-pocket medical expenses that are not covered by our family medical plan. Please let me know you thoughts. Thanks so much in advance for your time.

  5. Tony Novak, CPA Avatar
    Tony Novak, CPA

    Sure, a long as you meet the documentation requirements by March 31 as provided under the new law.

  6. Christopher V Avatar
    Christopher V

    Tony, thanks so much for your articles! They are very informative! I am 100% owner of an s-corp. I understand that I can participate in the HRA structure (NOT the new one for small businesses by Obamacare), however my reimbursements are treated as income on my W-2. What is the easiest and most cost-effective way of starting an HRA? At this time, I already submit a monthly Accountable Plan with my personal/family health insurance for reimbursement. Thank you for your help!

  7. Christopher thanks for the comment. What is the purpose of your current plan? It appears to provide no benefit to you. As you noted, a person deemed self-employed is not eligible for an HRA.

  8. Christopher V Avatar
    Christopher V

    Hello there! Apologies, I’m not sure how to answer your question. My current health insurance plan is a temporary plan that covers my wife and I. I lost my insurance back in January when I left an employer. My Accountable Plan reimburses my expenses each month for business mileage, home office, medical plan premium, etc. I am confused at your statement, “a person deemed self-employed is not eligible for an HRA.” I thought a 2%+ s-corp owner was … however not tax-free. What is your recommendation for reimbursing s-corp owners their premium AND expenses? Thanks sir!

  9. It may help to review IRS publications for confirmation that: 1) a person operating ans-corporation is deemed to be self-employed for purposes of this discussion and 2) a self-employed person is not eligible to participate in a HRA. Just google “IRS.gov” and the terms you which to verify. As you said, nullifying the tax effect by classifying it as taxable wages means that there is no consequence. That’s why I asked “why do it?”. Self-employed people may deduct the cost of health insurance on the 1040 income tax return. Self-employed people may not deduct the cost of out-of-pocket medical expenses. The best workaround to this restriction is a Health Savings Account. I’m not judging but your unusual terminology leads me to suspect that you should get a second opinion on your income tax accounting. Perhaps the concept of “accountable plan” was introduced to you by some firm who sells such services?

  10. Christopher V Avatar
    Christopher V

    Hello there. Sorry for the long pause. I’ve been out of town on business. This explains the concept of an Accountable Plan. I’ve read about it in other blogs and forums as well. http://www.watsoncpagroup.com/kb/what-is-an-accountable-plan_174.html

  11. I am the only full time employee of a church. We have an arrangement where I submit receipts for my individual health insurance premiums that I pay (coverage through the exchange), and they reimburse me. As a company with “fewer than two” full time employees, I understand that this arrangement is exempt from market reforms.

    – Do these reimbursement dollars need to be reported on my W-2?

    – Do I need to report these reimbursement dollars when I file my taxes? Will these reimbursement dollars reduce my premium tax credits dollar for dollar?

    I understand that under the QSEHRA/Small Business HRA arrangement legalized in December 2016 (21st Century Cures Act), reimbursements for a QSEHRA have to be reported on W-2s and they reduce premium tax credits. My question is: is my one-person arrangement subject to these same rules?–or not, because it’s the “fewer than two” category that is exempt from market reform to begin with?

  12. Hi Eric. It seems that you have a good understanding of the relevant issues regarding the employer’s reimbursement plan and you are looking for confirmation of the opinion that the church can continue to apply the tax treatment that was available before ACA and continues now. I concur.

    From your individual perspective, you are supposed to report your eligibility for employer reimbursements to the health insurance marketplace and this would reduce or presumably eliminate your premium tax credit. Marketplace procedures are outside my scope so you may need another source to verify this procedure about employer reimbursements.

    Best regards, Tony

  13. Thank you for your prompt reply and insight!

  14. Luke Estola Avatar
    Luke Estola

    Hello and thank you for the informative article. Our church has operated an HRA to reimburse our pastor for insurance premiums. He has been the only church employee so we believe it is allowed under the one participant exemption. He is planning to reduce his hours to about 18 hours a week and the church will hire a full-time pastor. The HRA will not be offered to the new pastor. If the church continues to reimburse the health insurance premiums of the part-time pastor will the arrangement still be exempt?

  15. Thanks for your comment Luke. It does appear possible that an HRA cold be designed to avoid conflict with the IRS non-discrimination rules of these plans as you desribe. That would be a function of the plan document itself. The second issue you raise is the treatment of the plan as the number of employees goes from one to two. Again, it appears to be possible to design the plan to comply with the American Cures Act of 2016. This is my most up-to-date commentary: http://tonynovak.com/taxation-of-health-insurance/

  16. I am reviewing comments in this thread in preparation of an update for 2018. Note that there at least one references to and outside source article that contains no references for its opinions. The opinions appear to be wrong. As always, who can’t believe everything you read on the internet. It is important to check for errors and intentional bias.

  17. Tony, thank you for the article. I have an LLC with 30 employees, most of them are part time. I want to offer HRA to my GM only. We use online payroll services. What all do I need to do to start the reimbursement? Can I just have a HRA policy document in place and start adding the reimbursement on payroll?

  18. ALex:
    You likely want to be sure that your HRA meets the non-discrimination testing requirements of Section 105(h) of the Internal Revenue Code. It is definitely possible, but your question does not contain enough information to comment further. Besides this question is likely best addressed in private, not on a public forum.

  19. […] In 2017, the most popular topic was health benefits. 20 Rules for Operating a Health Reimbursement Arrangement (HRA) […]

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