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Minimum essential coverage for QSEHRA with Gusto

Minimum essential coverage (MEC)* requirements under the Gusto QSEHRA 

*Minimum essential coverage (MEC) is required to obtain any reimbursements under a QSEHRA. MEC means health care coverage under any of the following programs that state “Yes” for Meets MEC Requirements. 

Plan type

Common carriers or plans

Meets MEC requirements?* 

Major medical plans

Individual health coverage

  • Health insurance purchased directly from an insurance company (for example, Blue Cross)
  • Health insurance purchased through the Healthcare.gov Marketplace, or the state marketplace (for example, Covered California)
  • Health insurance purchased through a student health plan
  • Catastrophic coverage
  • Coverage under an expatriate health plan for non-employees such as students and missionaries

Yes

Employer-sponsored group health plan from employee’s spouse

Ex: Blue Cross, United Healthcare, Aetna, Cigna, Kaiser

Yes, but Gusto will not currently support this form of insurance, as it is only eligible for post-tax reimbursements.

COBRA coverage

Health insurance from a previous employer which is not being funded with pre-tax money.

Yes

Government-Sponsored Programs

Coverage under Government-Sponsored Programs

  • Medicare Part A coverage
  • Medicate Part C coverage
  • Medicare Advantage plans
  • Most Medicaid coverage 
  • Children's Health Insurance Program (CHIP) coverage
  • Most types of TRICARE coverage
  • Comprehensive health care programs offered by the Department of Veterans Affairs
  • Health coverage provided to Peace Corps volunteers 
  • Department of Defense Non-appropriated Fund Health Benefits Program
  • Refugee Medical Assistance
  • Coverage through a Basic Health Program (BHP) standard health plan

Yes

Coverage under Government-Sponsored Programs
  • Medicare part B coverage
  • Medicare part D coverage
No

Medicaid programs providing limited benefits

Limited benefits Medicaid plans for emergency services, family planning services, treatment of specific diseases only, etc.

No

Limited benefit plans 

Short-Term, Fixed Indemnity, Accident

Ex: National General, Pivot, Philadelphia American

No

Sharing ministries

Religiously-affiliated health cost sharing ministries

Ex: Christian Healthcare Sharing Ministries, Samaritan’s Ministries, MediShare

No

Cash benefit plans

Critical Illness, Gap, Out-of-Pocket plans

Any plan that pays cash for illness or injury instead of providing a medical benefit

No

Excepted benefits

Specific diseases such as cancer, life, disability 

Excepted benefits include stand-alone vision and dental plans, workers' compensation coverage, and coverage limited to a specified disease or illness.

No

Payroll, benefits, HR and more.