Health Benefits
QSEHRA vs. ICHRA for startups
How two health reimbursement arrangements differ for small teams.
Denta team · · 1 min read
QSEHRA and ICHRA both let employers reimburse eligible health expenses, but they have different eligibility and design rules. Start with whether your company offers a group health plan and how many employees it has.
The core difference
| Question | QSEHRA | ICHRA |
|---|---|---|
| Employer size | Generally fewer than 50 full-time employees | Generally available to employers of any size |
| Group health plan | Employer generally cannot offer one | Rules differ by employee class |
| Annual contribution | Subject to an IRS limit | Employer sets the allowance |
HealthCare.gov sets out QSEHRA requirements and current limits and describes ICHRA eligibility. These are medical coverage arrangements; neither is Denta's dental plan.
Look beyond the employer allowance
Employees need qualifying coverage to use the arrangement under its rules. The offer can also change eligibility for Marketplace premium tax credits. Ask a benefits adviser to model those effects for your actual workforce before choosing. HealthCare.gov notes the QSEHRA premium tax credit interaction.
For the wider choice between group coverage and reimbursement, read our health benefits for startups guide.