Yes, those covered on a spouse's employer group plan can participate in the QSEHRA. Remember: You must be covered by Minimum Essential Coverage (MEC) to receive QSEHRA reimbursements. Coverage through a spouse's group plan does qualify as MEC.
If you’re covered by your spouse’s group plan there are some nuances to know regarding premium reimbursement:
First, verify whether your employer has elected to include spouse group plans in the QSEHRA.
Next, only the portion of the group premium that is not paid for by your spouse’s company is eligible for reimbursement. For example, let’s say your spouse’s plan costs $1,000/mo total. Your spouse’s company kicks in $400/mo to help cover the cost. Only the remaining $600 would be eligible for QSEHRA reimbursement (if allowed by the employer, see step 1 above).
Finally, most group plans are already paid for on a pre-tax basis on your spouse’s paycheck. In the example above, even though you’re paying $600/mo to cover the difference, your spouse is likely able to pay for it pre-tax on his or her paycheck. This is great! However, the IRS doesn’t want you to “double dip” and also get a pre-tax QSEHRA reimbursement. As a result, your QSEHRA claim for your premium will likely be paid on a taxable basis unless you can show the premiums were paid post-tax by your spouse (very rare).
See IRS Notice 2017-67 Q48 if you’d like to dive into the weeds!
If you have an individual dental or vision plan, separate from your spouse's group health plan, those premiums can be reimbursed tax-free.
If your employer has elected to reimburse for both premiums and medical expenses, your claims for one-time medical expenses can be reimbursed tax-free.