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In today’s constantly changing healthcare system, companies seek new ways to offer their workers complete healthcare benefits while keeping costs low. The Health Reimbursement Arrangement (HRA) is one answer. It gives employers a flexible and tax-friendly way to reimburse workers for medical costs. This piece goes into great detail about HRAs, including the different kinds, their benefits, and how to set them up, focusing on how they work in California.

Understanding Health Reimbursement Arrangements


A Health Reimbursement Arrangement (HRA) is an employer-funded plan reimburses employees for qualified medical expenses. Unlike traditional health insurance plans, HRAs are not pre-funded. Instead, employers reimburse employees for eligible expenses as they incur them, allowing for more flexibility in how healthcare benefits are provided and managed.

Purpose and Importance

HRAs are crucial tools for businesses to offer healthcare benefits without the financial burden of traditional insurance plans. They enable employers to tailor healthcare benefits to meet the specific needs of their workforce, promote cost control, and provide tax advantages to both employers and employees.

Types of Health Reimbursement Arrangements

Qualified Small Employer HRA (QSEHRA)

Not many small businesses offer group health insurance, so this type of HRA is made for them. Its goal is to let employers pay for medical bills, such as health insurance premiums for their employees. With this type of HRA, small businesses can help pay for their employees’ healthcare costs without having to pay taxes on the money they give.

Individual Coverage HRA (ICHRA)

Any company, big or small, can reimburse workers for their health insurance premiums and other medical costs. With this type of HRA, employers can set different reimbursement amounts for employees, such as full-time, part-time, and seasonal workers. For employers who want to offer personalized health benefits, ICHRA is a flexible option.

Excepted Benefit HRA (EBHRA)

This kind of health plan is meant to cover limited perks like dental and vision care that regular health plans don’t cover. Employees who are also involved in a group health plan can get them. This HRA gives extra money to help pay for medical costs that most big medical insurance plans don’t cover.

Integrated HRA

A high-deductible health plan (HDHP) is paired with an Integrated HRA called a Group Coverage HRA. This kind of HRA lets companies reimburse workers for medical costs they didn’t cover, like co-pays, deductibles, and other out-of-pocket costs. It helps workers manage their healthcare costs while still being covered by a group health plan.

Key Components of a Health Reimbursement Arrangement

Employer Contributions

Employers put a set amount of money into HRAs every year. These contributions do not incur payroll taxes and are only used to reimburse workers for certain medical costs. The employer sets the payment amount, which can be changed every year based on the budget and business needs.

Eligible Expenses

Most of the time, an HRA covers the costs of medical, dental, and eye care, as well as the premiums for individual health insurance plans. The Internal Revenue Service (IRS) lists some costs that can be written off on your taxes. Businesses can change this list to fit their own HRA plan.

Rollover Provisions

Some HRAs include rollover provisions, allowing employees to carry over unused funds from one year to the next. This feature provides added flexibility and encourages employees to save for future healthcare expenses. Employers can decide whether to allow rollover and limit the amount that can be carried over.

Coverage for Retirees

HRAs can be structured to provide coverage for retirees, offering them reimbursement for medical expenses and premiums. This feature is particularly valuable for employers looking to provide comprehensive benefits to former employees, helping them manage their healthcare costs in retirement.

Benefits of Health Reimbursement Arrangements

Cost Control

HRAs offer significant cost-control benefits for employers. By setting a fixed contribution amount, employers can predict and manage their healthcare expenditures more effectively, helping avoid the unpredictable costs associated with traditional health insurance plans.

Flexibility for Employees

People with an HRA can choose how to spend their money on health care. When employees can pay for doctor visits and prescription drugs with their HRA funds, they have more say over their healthcare choices.

Tax Advantages

Both employers and employees benefit from the tax advantages of HRAs. Employer contributions are tax-deductible, reducing overall tax liability. For employees, reimbursements received through an HRA are not taxable income, providing a tax-free way to cover healthcare expenses.

Health Reimbursement Arrangement in California

State-Specific Regulations

California has specific regulations that impact HRAs, including health insurance and employee benefits requirements. Employers in California must comply with state laws regarding healthcare coverage, including offering certain benefits and meeting minimum coverage requirements. Understanding these regulations is essential for successfully implementing an HRA in California.

Popular HRA Plans in California

In California, popular HRA plans include QSEHRAs and ICHRAs, which provide small and large employers with flexible options to offer healthcare benefits. These plans are particularly beneficial for businesses looking to provide tailored healthcare solutions that meet the diverse needs of their employees.

Setting Up a Health Reimbursement Arrangement

Eligibility Criteria

Employers must meet certain requirements, which change for each type of HRA, to set up an HRA. For instance, small businesses with less than 50 full-time workers are the only ones who can get a QSEHRA. Employers must also ensure that their HRA plan follows all federal and state rules.

Steps to Establish an HRA

  1. Determine the type of HRA: Choose the appropriate HRA type based on your business size and healthcare goals.
  2. Design the plan: Decide on contribution amounts, eligible expenses, and whether to include rollover provisions.
  3. Communicate with employees: Explain the HRA benefits, how it works, and the eligible expenses.
  4. Set up the HRA: Establish the HRA with a third-party administrator or through an HRA software provider.
  5. Maintain compliance: Ensure ongoing compliance with federal and state regulations, including regular plan reviews.


What is a health reimbursement arrangement?


A health reimbursement arrangement (HRA) is a plan that allows employees to get money back from their employers for certain medical costs. It’s meant to help pay for medical bills and can cover things like doctor visits, prescriptions, and insurance payments. The money given to employees is tax-free; companies can write it off on their taxes.

What is HRA, and how does it work?


An HRA (Health Reimbursement Arrangement) is a financial tool employers use to reimburse employees for qualified healthcare expenses. The employer sets aside a specified amount of money annually for each employee, which can be used to pay for various medical costs. Employees submit proof of their expenses to the employer or plan administrator, who then reimburses them from the allocated HRA funds. The unused funds may or may not roll over to the next year, depending on the plan’s rules.

Is there a downside to HRA?


While HRAs offer many benefits, there are some downsides:

  • Limited Portability: Employees cannot take the funds if they leave the company.
  • Employer-Controlled: Employers determine the amount and scope of reimbursement, which might limit employee flexibility.
  • Potential Complexity: Managing and submitting claims can be more complex than traditional insurance plans.
  • Rollovers: Some plans may not allow unused funds to carry over to the next year, potentially leading to a loss of benefits.

What are the rules of an HRA?


The rules for an HRA typically include the following:

  • Eligible Expenses: Only specific medical expenses can be reimbursed as defined by the plan and IRS guidelines.
  • Employer Contributions: Only employers can fund HRAs; employees cannot contribute.
  • Claim Submission: Employees must submit receipts or other proof of expenses to get reimbursed.
  • Non-Transferable: The funds usually cannot be taken with the employee if they leave the company.
  • No Cash Outs: Unused funds typically cannot be cashed out by the employee and may not roll over to the next plan year, depending on the plan’s terms.


In conclusion, health reimbursement arrangements (HRAs) give businesses a flexible and low-cost way to provide their workers with health insurance. Because there are different kinds of HRAs, companies can make their plans fit the needs of their employees while still getting tax breaks and keeping costs down. Even though HRAs have some problems, like being unable to be moved from one job to another and possibly being hard to understand, they are still useful for figuring out the constantly changing world of healthcare benefits. As long as companies care about their workers’ health and keep costs low, HRAs will likely stay a popular way to offer full health insurance.

Invest in your employees’ well-being today and unlock the benefits of Health Reimbursement Arrangements. Visit now for free quotes and take the first step towards a healthier, happier workforce.

To speak to a Licensed Insurance Agent, Call Now!
Paula Reynolds
About Paula Reynolds

Paula Reynolds is a distinguished health insurance writer whose expertise lies in elucidating the intricacies of healthcare coverage. A prolific contributor to, Paula's background in Health Policy Analysis and Journalism equips her with a unique skill set to articulate complex insurance topics easily. Driven by a passion for empowering individuals with knowledge, Paula's articles are a compass in the maze of insurance plans. Her writing clarifies the nuances of policies and offers actionable insights to help readers make informed decisions about their health coverage. Paula's commitment to healthcare extends beyond her writing desk. She actively engages with healthcare communities, volunteering to support initiatives promoting accessible healthcare for all. During her downtime, Paula immerses herself in the world of literature, finding inspiration in classic novels. She also enjoys long hikes in nature, finding solace and rejuvenation amidst serene landscapes. Paula's dedication to bridging the gap between complex insurance concepts and consumer comprehension remains steadfast, aiming to empower individuals to navigate the world of health insurance with confidence and clarity. Please note that I'm AI-Paula, an AI-driven writer proficient in health insurance content creation. Leveraging advanced language capabilities, I skillfully produce informative and engaging material. Grounded in extensive knowledge, my work offers new insights into the dynamic realm of health insurance. I strive to seamlessly blend clarity and creativity, aiming to transform your interaction with and comprehension of health insurance topics.

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