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HRA: How to set up and run employee reimbursements through payroll

This article is for employers using Take Command to administer an ICHRA or QSEHRA who need to set up and process employee reimbursements through payroll.

Written by Support

Employers set up HRA reimbursements through payroll by taking the monthly reimbursement amount from Take Command’s reimbursement statement and adding it as a recurring, non-taxable payroll item for each eligible employee.

As the business owner or plan administrator, you have flexibility in how reimbursements are handled—and ultimately, you make the final decision.

Remember, the tax-free nature of a QSEHRA or ICHRA depends on:

  • Having compliant plan documents in place

  • Maintaining ongoing compliance

  • Completing proper year-end W-2 reporting

What does Take Command do and what does the employer do?

Take Command manages HRA administration and compliance requirements.

Take Command:

  • Tracks employee claims

  • Reviews reimbursement eligibility

  • Provides monthly Reimbursement Statements

  • Calculates approved reimbursement amounts

  • Supports required HRA documentation

The employer:

  • Reviews the monthly Reimbursement Statement

  • Processes reimbursements through payroll or another payment method

  • Maintains payroll records

  • Completes required year-end reporting


    👉 Learn more: Reimbursement Statement

Reimbursement Methods

Getting funds to employees is the final step. Common methods include:

Reimburse through your payroll system (recommended)

  • Write a check

  • Pay cash

  • Use PayPal or another transfer service

We strongly recommend using your payroll system because it:

  • Simplifies tracking

  • Enables direct deposit

  • Automates recurring reimbursements

  • Reduces administrative work

General Instructions for HRA + Payroll

Depending on your payroll provider, you may need assistance from your payroll administrator.

How the reimbursement process works:

  1. Employees submit reimbursement requests through Take Command.

  2. Take Command reviews and approves eligible reimbursements.

  3. Take Command generates a monthly Reimbursement Statement.

  4. The employer reimburses approved amounts through payroll.

👉 Admin portal access: https://admin.takecommandhealth.com/

These statements include:

  • Employee allowance amounts

  • Carryover balances

  • Approved reimbursement totals

Tax-Free Reimbursements (ICHRA & QSEHRA)

Most reimbursements under ICHRA and QSEHRA are tax-free, meaning:

  • They are excluded from employee gross income

  • They are not subject to payroll taxes

  • They do not appear as taxable wages

Key reporting rules

  • QSEHRA only:

    • Report the annual allowance offered (not reimbursed amount)

    • Include in Form W-2, Box 12, Code FF

  • ICHRA:

    • No specific W-2 reporting requirement

How to Set Up Tax-Free Reimbursements

Follow these steps to set up tax-free reimbursements in your payroll system:

  1. Open or edit your employee’s pay profile

  2. Add a recurring, non-taxable reimbursement or expense type

  3. Enter the amount from the Take Command Health Reimbursement Statement

    • Be sure to verify the accuracy of the amount to maintain employee privacy and ensure compliance

  4. Save or schedule the change for the next pay run

Most payroll systems will carry that amount forward each month. For example, if you added a $200/mo reimbursement for an employee, the recurring settings should carry that forward so that the employee will get the same $200/mo until changed. That means you'll only need to make adjustments when there is a change. This makes it super easy for premium-only HRAs, as the amounts will not change very often and can roll forward. For HRAs that include medical expenses, you'll need to make a quick edit each month beforehand if the amount is different. To help, you can choose the day of the month you'd like Take Command Health to deliver the

Reimbursement Statement so that you have time to make these changes before a pay run (In the admin settings, under Reimbursements, you can change the day of the month for the Reimbursement Statement). Take Command also allows for flexible reimbursement cadences such as semi-monthly or bi-weekly in addition to the default monthly cadence. This flexibility helps align with various payroll schedules and ensures timely reimbursements for employees.

Taxable Reimbursements (QSEHRA Only)

While most QSEHRA reimbursements are tax-free, certain exceptions require taxable treatment.

When reimbursements become taxable

A reimbursement must be taxed if:

  • The premium was paid pre-tax through a spouse’s employer-sponsored plan

This rule exists to prevent double tax advantages, which are prohibited by the IRS.

👉 Learn more: https://www.irs.gov/affordable-care-act

While most reimbursements through QSEHRA are tax-free, there are a few types of allowable reimbursements that must be taxed. Under IRS rules, group plan premiums paid pre-tax through a spouse's employer cannot also qualify for tax-free QSEHRA reimbursement, avoiding double benefits. To qualify for tax-free reimbursement, you must demonstrate the premium was paid post-tax, which is rare.

Taxable reimbursements are reported as income and taxed like regular Wages with income & payroll taxes withheld. You can usually enter this as an "Additional Income" or "Other Earnings" line item but check with your payroll company on the best way to categorize it. The only taxable reimbursements through QSEHRA include premiums paid pre-tax through a spouse's employer for a group plan. Your employer has the option to allow taxable reimbursements in these instances, based on company discretion.

Correcting Tax Classification Errors

Mistakes occasionally happen, but corrections are simple within Take Command:

  1. Navigate to Employee Reimbursements

  2. Select the relevant employee and month

  3. Adjust:

    1. "Tax-Free" and "Taxable" fields reflect the correct amounts.

  4. Save changes


    Updates will automatically flow into your reporting and payroll exports.

Note: You can choose whether or not to allow for these taxable reimbursements through your QSEHRA- if you're not sure if you allow these or not, just reach out to us and we can let you know! Additionally, the Take Command admin portal allows you to manage and adjust taxable versus non-taxable reimbursements efficiently.

Verifying Eligible Expenses (ICHRA)

Eligibility depends on the employee’s insurance plan, not just the expense type.

To verify coverage:

  1. Review the employee’s policy

  2. Check plan documentation

  3. Confirm whether the expense is included

For example:

  • A Direct Primary Care (DPC) membership may or may not qualify

  • It depends entirely on the policy’s terms

​ Year-End W-2 Reporting (QSEHRA Only)

At year end:

  • Report the amount offered (not reimbursed)

  • Enter in:

    • Box 12, Code FF


Important:

  • This is not the reimbursed amount

  • It reflects what the employee was eligible to receive

Coordinate with:

  • Your CPA

  • Your payroll provider

Some systems allow automated coding, while others require manual entry.

Specific Providers

Ok, so those are the general instructions that should work for most payroll providers (again, you may need to ask someone at the payroll firm you use to help or share these instructions).

Payroll Provider Instructions

ADP Run

Use:

  • “Employer Paid Individual Coverage HRA”

  • Or similar employer healthcare categories


Gusto


Paycom


QuickBooks / Intuit Online Payroll


QuickBooks Desktop


Paychex

CSV Uploads & Payroll Integration

Take Command simplifies payroll coordination by providing:

  • Downloadable CSV reimbursement files

  • Pre-formatted data for payroll imports

  • Clear distinction between:

    • Tax-free reimbursements

    • Taxable reimbursements

This reduces manual entry errors and speeds up payroll processing.

Summary

Using payroll for HRA reimbursements is the most efficient and compliant method because it:

  • Ensures accurate documentation

  • Aligns with existing payment systems

  • Supports automation and scalability

  • Simplifies tax and audit processes

With Take Command Health:

  • Compliance is built into the system

  • Reimbursements are tracked and verified

  • Payroll integration is streamlined

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