A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is an employer funded “health plan” that may be used to reimburse employees for qualified medical expenses, including individual health insurance premiums. 

A QSEHRA generally is funded solely through your employer’s contributions without any employee salary reduction contributions. You must provide proof of Minimal Essential Coverage (MEC) as defined by the ACA before you and your family members are reimbursed for any incurred qualified medical expenses. Annual reimbursement limits for a QSEHRA are $5,050 per employee or $10,250 per family. If your coverage is for less than an entire year, these limits would be prorated. 

You can be reimbursed for qualified medical expenses purchased for you and your family or the funds may be used to reimburse health insurance premiums. Each expense submitted for reimbursement must include documented proof that it was a qualified medical expense before Surency can reimburse you. You can be reimbursed for expenses incurred as of the effective date of the QSEHRA or the date the eligible employee first became eligible for the QSEHRA (not before). You cannot be reimbursed for expenses that were deducted from any prior year tax returns. 

For an employee who enrolls in a qualified health plan on the Health Insurance Marketplace, his/her health care premium tax credit may be reduced or eliminated by the benefit available under the QSEHRA.

Complete and submit to Surency a QSEHRA claim form along with the appropriate documentation for processing. The claim form can either be mailed to Surency at P.O. Box 789773, Wichita, KS 67278-9773 or faxed to 316-462-3392.  

A QSEHRA claim form is available within the Forms section.  

Surency’s QSEHRA claim form provides detailed instructions as to what is acceptable documentation. The IRS rules require any claim to be substantiated and supported by backup documentation in order to be reimbursed. The backup documentation must include the date of service, description of services rendered, for whom the services were rendered, and the dollar amount of the services rendered. Any third-party documentation including this information will suffice. Here are some common examples of acceptable documentation:

• Explanation of Benefits (EOB) statement from the insurance carrier (the summary of services rendered sent out by the insurance company after services are provided);
• Co-pay receipts are covered if the eligible employee is under a managed care or prescription drug program; and
• Itemized bill that provides the name of the provider, patient, cost, date, and description of service.

There are specific IRS rules for recurring claims, which must be followed in order to take advantage of the QSEHRA benefit. Surency must receive documentation each and every month to process the claim. However, the documentation required is relaxed after the initial set-up of the recurring claim. The claim form also provides additional instructions as to what documentation is acceptable.

When requesting a recurring claim, you must submit documentation that contains the following information: completed and signed QSEHRA claim form, date of service or term of the agreement, services rendered, recipient of the services rendered, and cost of service.

Once the initial claim has been setup, there is a decreased burden of proof for subsequent reimbursements. You will only need to send either a proof of payment or proof that the claims were incurred such as a letter from the insurance company showing the policy still in force, monthly statement, etc.

No. The IRS prohibits paying claims prior to the claim being incurred. You would need to wait until a particular expense has been incurred prior to submitting a claim for reimbursement. The IRS regulations provide that the term “incurred” refers to the date you or your family member is provided with the care that the particular expense comes from. This date could be different from the date you were billed or paid for the expense.

No. A QSEHRA may not reimburse any qualified medical expenses that are attributable to a deduction allowed in any prior taxable year. Also, a QSEHRA may not reimburse a qualified medical expense that is incurred before the date you became eligible for the QSEHRA.

Death benefits cannot be provided under a QSEHRA. Amounts in the account can only be used for qualified medical expenses. This is because IRC Section 105 provides an exclusion from tax only if amounts are used for qualified medical expenses. Amounts remaining in the account at death may be used to reimburse qualified medical expenses for the family members so long as the employer applies such terms uniformly to all employees. 

No. Your right to the QSEHRA account terminates at the end of the last day of employment. The employer has the discretion of determining how they would like to address what happens when an eligible employee terminates employment such as terminating access at the end of the last day of employment, the last day of the pay period, or at the end of the month.