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  • Writer's pictureAhsan Malyk

Are Health Insurance Reimbursements Taxable?

There are numerous ways available to pay back employees' health insurance costs. Many organizations are moving away from traditional employer-sponsored group health insurance in favour of more specialized benefits due to the rising cost of health insurance.

Benefit reimbursements are a fantastic method for businesses to cut healthcare costs while giving employees a more specialized benefits package. However, certain payments for health insurance are tax deductible, while others are not.

With so many options available, it can be confusing to know which health insurance reimbursements are taxed and which aren't.

Health reimbursement arrangements (HRAs) and health stipends, two of the most common forms of healthcare compensation, will be covered in this article. We'll look at which perks are exempt from taxes and which are treated as income.

Are HRA reimbursements tax deductible?

In accordance with Internal Revenue Service (IRS) regulations1, companies may provide tax-advantaged reimbursement to employees for qualified medical expenses and health insurance. An HRA is the most well-known method for doing this.

Employers can reimburse employees for medical costs, such as health insurance premiums, with money that is free from payroll taxes for both the employer and the employee when an HRA complies with federal regulations. If the employee has individual health insurance with minimum essential coverage, an HRA may also be tax-free for them (MEC).

However, in order to receive the tax advantages of this health plan, an HRA must adhere to IRS guidelines, which include tight guidelines for creating formal plan documentation.

HRA specifications

The IRS has established clear guidelines for how HRAs operate and how businesses must put them up to be in compliance.

An HRA must fulfil the following criteria in order to qualify for tax relief benefits:

  • Employees cannot contribute; the company must entirely support it.

  • The organisation cannot pay for its contribution through wage deductions, even if the employee agrees to it.

  • To receive tax-free payments, employees must have MEC.

At the end of the year, employees who don't have MEC are required to submit reimbursements as taxable income. Qualified medical expenses must be specified in the formal plan documentation.

Annual contribution caps apply to some HRA types, such as the qualified small employer HRA (QSEHRA), but not to others, such as the individual coverage HRA (ICHRA) and the group coverage HRA (GCHRA).

HRA adherence

Healthcare reimbursement programmes must include official plan documents that outline how the plan is handled, what medical expenses are eligible for reimbursement, and what paperwork is needed to prove compliance in order to be compliant.

Employers can just offer employees raises or health insurance benefit stipends if they want to avoid setting up legal documentation and processes to obtain these pre-tax advantages. However, the business must pay payroll tax on these additional wages, and the workers must pay income and payroll taxes.

What is the HRA's process?

Employees may use their HRA to purchase individual health insurance through the federal or state marketplace. Employees request reimbursement for their out-of-pocket health care and premium payments.

Employers construct their plans to reflect the expenses they wish to be eligible for reimbursements, such as healthcare premiums alone or all eligible expenses, and they set monthly allowance limitations for reimbursement.

Employees are compensated up to their allotted allowance after providing proof of their medical bills and other qualifying expenses. Because of this, an HRA is a very flexible and unique benefit choice.

The following are the top three HRA types:

The acceptable tiny business HRA (QSEHRA): A fantastic choice for businesses with fewer than 50 full-time equivalent workers (FTEs). The IRS limits annual employer contributions.

The personal insurance ICHRA (HRA) An ICHRA, which is accessible to enterprises of all sizes, enables customization across several employee classifications, including full-time employees, salaried employees, and more. It also enables you to fulfil the employer mandate of the Affordable Care Act (ACA) for relevant large enterprises (ALEs).

The group coverage HRA (GCHRA), commonly referred to as an integrated HRA, is a choice for businesses looking to add to their current group health insurance plans. You cannot reimburse workers for individual health insurance premiums under a GCHRA.

How are medical assistance payments taxed?

There are other options besides HRAs for covering employees' medical costs. There are also stipends for employees.

Healthcare stipends are treated as taxable income, unlike an HRA. This is because stipends don't have as many restrictions on what counts as "eligible employee costs" as do formal employer-sponsored health insurance plans. Stipends, like bonuses, are not tax deductible and are instead included in the employee's taxable income.

Employers must pay payroll tax on stipend money used to cover out-of-pocket medical expenses or medical insurance premiums. However, you are not compelled to withhold Medicare or Social Security taxes. In addition to their income tax, employees are also liable for paying these taxes.

Stipends are included in Form W-2 papers, so employees should set aside the necessary funds to cover their taxes.

Why would you decide to provide a taxed health allowance?

Stipends are a straightforward benefits solution for small firms because they are less regulated than other benefits.

Medical insurance is not required for your employees to take part in a stipend. This makes it possible for stipends to pay for a variety of healthcare costs for workers, regardless of whether they already have insurance, a health savings account (HSA), or flexible spending accounts (FSAs).

Additionally, it enables your employees who take part in premium tax credits to profit from these features without having to reduce or forfeit their premium tax credits by the amount of their allowance.

Taxable stipends might assist employees with additional out-of-pocket medical expenses if they already have a group health insurance plan or an HRA. Just taxes will need to be paid on these additional allowances.

Stipends also offer wellness benefits, promote better well-being through a personalized wellness program, and offer taxable compensation for mental health services that might not be covered by HRAs or group health insurance.

Stipends are more effective at luring and keeping personnel than just increasing salaries to meet medical costs since your staff views them as additional fringe benefits.

Despite being treated as taxable income, stipends can offer employees a number of advantages.


HRAs are a wonderful choice for firms who wish to provide their staff with individualised, flexible health benefits due to their tax advantages. But compliance is crucial. Without it, tax benefits for both businesses and employees may be lost.

On the other side, a nice perk that goes along with providing health insurance is a taxable healthcare or wellness stipend.

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