A QSEHRA is a tax-free employer-funded benefit that reimburses employees for eligible health insurance premiums and medical expenses, as long as the employee maintains Minimum Essential Coverage (MEC) and submits valid documentation through the reimbursement process.
What is a QSEHRA?
A QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) is a health benefit where:
Your employer sets a monthly allowance
You choose your own individual health insurance plan
You submit eligible expenses for reimbursement
Reimbursements are tax-free if IRS requirements are met
It is designed for small employers with fewer than 50 full-time employees.
Eligibility Requirements
The good news is there is only one requirement for employees to meet in order to participate in a QSEHRA and receive the tax-free benefits! Employees must be covered by Minimum Essential Coverage (MEC) to receive QSEHRA reimbursements. Most plans today meet MEC requirements, including: plans purchased from the marketplace, employer group plans, COBRA, TRICARE, MEDICARE (A or C), Medicaid, and more. QSEHRA benefits are offered to employees of the business only. Spouses are not directly eligible for these benefits. However, employees can add their spouses as dependents on individual health insurance plans and request reimbursement for their premiums according to the plan design. While faith-based sharing plans are exempt from MEC requirements, the QSEHRA regulations do require MEC, and sharing plans therefore do not qualify for tax-free reimbursement through QSEHRA without a supplemental MEC plan. You can read more about that here!
Plans that do not qualify as MEC include: critical illness, indemnity, short-term plans, vision or dental only, or plans that only offer discounts on medical services.
Getting Started
Enrolling in your QSEHRA is easy with Take Command Health. All employees will receive an email inviting them to sign up. It takes just a few minutes to complete your enrollment information and upload your proof of insurance coverage. Take Command Health will verify your eligibility. Employees who leave the company or become ineligible for QSEHRA allowances have a 90-day runout period to submit reimbursement requests for expenses incurred while they were still eligible.
Submitting Expenses for Reimbursement
Insurance Premiums
Your QSEHRA could be set up either to reimburse premiums only or to reimburse premiums + medical expenses. Your employer will be able to tell you which type of plan you have or you can look in your detailed Plan Summary.
Health, Dental, and Vision insurance are eligible for premium reimbursement. Through your member portal, you can set up these monthly premium payments as recurring expenses by providing proof of your premium. Once we have confirmed your premium amount, Take Command Health will set up your premium for automatic reimbursement each month, saving you the task of remembering to submit your monthly premium for reimbursement! Reimbursement for Medicare premiums is capped at the actual premium expense incurred by the employee each month. Similarly, COBRA premiums can be reimbursed if the QSEHRA plan permits it and the individual meets MEC requirements.
It's also important to remember that Critical Illness, Life Insurance, and Indemnity Plans are not eligible for reimbursement.
First, most group plans are already paid on a pre-tax basis on your spouse’s 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 will be reimbursed 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!
Next, only the portion of the group premium that is not paid for by your spouse’s company is eligible for reimbursement.
Finally, verify whether your QSEHRA includes taxable reimbursements in order to be reimbursed for your premium through your spouse's group plan.
If your QSEHRA does not allow for taxable reimbursements but does allow for medical expense reimbursement, read on! Your spouse's group plan does qualify as MEC and you can use your entire allowance to be reimbursed for medical expenses TAX-FREE!
Medical Expenses
If your QSEHRA is set up to reimburse for one-time medical expenses in addition to monthly premiums, you can submit receipts for reimbursement through your member portal.
You will need to provide the date of service, cost, and submit a receipt.
For an expense to be eligible for reimbursement, it must have been incurred on or after your QSEHRA start date (not the date billed).
You can submit an expense that is larger than your monthly allowance. The balance will be paid off in the future months.
If you are unable to use your entire balance one month, it will carry forward each month until year end. Premiums paid in advance are eligible for reimbursement as long as the covered period aligns with the plan year.
Reimbursements
Take Command Health will track your expenses for your employer. We'll provide reports to your employer indicating how much employees have claimed for reimbursement. After the employer has reviewed the report they will reimburse employees tax-exempt. Please note: Take Command Health will not be reimbursing employees.
Have questions?
We're here to help! E-mail us at support@takecommandhealth.com, or chat with us directly on the website.
Frequently asked questions
Why does my balance show $0 if I have a monthly allowance?
A $0 balance typically means your recurring insurance premium has already consumed your entire year-to-date allowance. Each approved or pending recurring premium reimbursement reduces your available balance. Once the sum of monthly premiums equals your annual allowance, no balance remains for medical expenses.
If your plan is premiums-only (not configured to reimburse medical expenses), your Add Expense button will also be unavailable — this is intentional, not a bug.
What happens if my balance runs out before the end of the year?
Once your Current Year Balance reaches $0, no further reimbursements can be approved until the next plan year begins and new monthly allowances accumulate. Claims submitted when the balance is $0 will be tracked but not reimbursed until allowance is available in the next plan year — check with your employer whether year-to-year rollover is enabled in your plan.
How long does it take to receive my reimbursement after my claim is approved?
Take Command reviews and approves claims, then provides your employer with a monthly reimbursement report. Your employer issues payment on their own payroll or reimbursement schedule. The typical end-to-end timeline is 2–6 weeks from claim submission to payment. If your claim has been Approved for more than one full payroll cycle, contact your HR or payroll team to confirm when payment will be issued.
Can I submit reimbursements for the months before I uploaded my proof of coverage?
Yes — reimbursements are calculated retroactively to your QSEHRA eligibility start date. If you were eligible but did not upload proof of coverage right away, you can still submit claims for prior months as long as the plan year is still open. Contact Customer Experience to confirm which months are eligible for retroactive submission based on your specific plan.
What do I do if the Add Expense button is missing entirely?
If the Add Expense button does not appear at all (not just greyed out):
Confirm you are signed into the Employee Member Portal (HRA Hub or takecommandhealth.com/member-portal), not the Employer Admin Portal.
Check whether your proof of coverage has been approved — the button does not appear until proof is approved.
Contact your employer to confirm whether your QSEHRA plan is configured to allow medical expense reimbursements — some plans are premium-only.
If all of the above are confirmed and the button is still missing, contact Customer Experience with your name, company name, and a screenshot.