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QSEHRA basic information, for employees

Eligibility

To be eligible for QSEHRA through Gusto, you must:

  1. Have health insurance that meets Minimum Essential Coverage (MEC) requirements. MEC plans include individual plans from a marketplace, government plans like Medicare and Medicaid, and student health plans. 
  2. Be a full-time employee. Contractors and part-time employees are not eligible for this benefit.
  3. Be the primary subscriber on your insurance policy—meaning, you're not covered as a dependent through a parent or spouse.
  4. NOT be a 2% shareholder. These employees should contact their personal tax advisor to find out their options.

You’ll need to submit documentation, like a monthly premium bill, to prove that your health insurance meets MEC requirements. This documentation should include: 

  • The dollar amount of your premium 
  • The name(s) of the individual(s) covered by your insurance policy
  • Your dates of coverage 
  • The date of your bill
  • And the name of the medical plan

Keep in mind that you’ll need to submit this proof each time you request a reimbursement.

QSEHRA, and ACA Premium Tax Credit eligibility

If you currently receive Premium Tax Credits (PTCs) through the Affordable Care Act (ACA) and your employer offers QSEHRA, your PTCs may be reduced or eliminated—even if you choose not to receive QSEHRA reimbursements.

If you currently receive PTCs, you’ll need to report the amount of your QSEHRA benefit. Your W-2 will also reflect the amount your employer offers through QSEHRA, even if you didn’t request reimbursements.

Getting reimbursed 

When you request a reimbursement, we'll verify the amount with the documentation you provide. If the documentation provided is complete and accurate Gusto will approve the amount, and employees will see their reimbursement amount reflected in one or two paychecks.

Under the QSEHRA with Gusto, you can request to be reimbursed for: 

  • Monthly health insurance costs from qualifying health plans. Keep in mind that medical expenses, dental premiums, and vision premiums are not eligible expenses under the QSEHRA with Gusto.
  • Dependent coverage. You’ll need to provide proof of MEC for your dependents, too.

Your QSEHRA benefit amount will roll over month-to-month during your plan year, but will not roll over for the following year.

Payroll, benefits, HR and more.