QSEHRA vs ICHRA — Which Reimbursement Option Works Best for Idaho Small Employers?
Chris Antrim, CLTC - Boise Health & Life Agency • August 29, 2025
QSEHRA is simple for very small teams; ICHRA scales with classes and budget control. We design, educate, and manage onboarding so benefits are easy to use.
Quick Definitions
- QSEHRA: For eligible small employers without a group plan; reimburse employees tax‑advantaged for individual coverage up to annual limits.
- ICHRA: Available to employers of any size; set allowances by classes (full‑time, part‑time, seasonal, etc.) and reimburse premiums/qualified expenses tax‑advantaged.
Side‑by‑Side Snapshot
| Factor | QSEHRA | ICHRA |
|---|---|---|
| Employer Size | Qualifying small employers | Any size |
| Design Flexibility | Simpler; single allowance | Highly flexible classes/allowances |
| Budget Control | Good | Excellent |
| Compliance | Notices, substantiation | Notices, affordability if replacing group |
| Employee Experience | Simple reimbursements | Wide ACA choice + guidance |
When QSEHRA Fits Best
Very small Boise teams wanting straightforward reimbursements without running a group plan. We set allowances, prepare notices, and coach employees to select compatible ACA plans through Your Health Idaho.
When ICHRA Wins
Growing employers who need different allowances by role or location, want budget certainty, and prefer employees to pick their own networks (e.g., St. Luke’s vs St. Alphonsus). Class design and affordability rules require careful setup—we handle the details and employee education.
Implementation Roadmap
- Define objectives and budget.
- Choose QSEHRA or an ICHRA class structure.
- Draft required notices and set up substantiation.
- Employee training with office hours and simple how‑tos.
- Reimbursement platform onboarding and payroll coordination.
- Renewal plan with communications and metrics.
Case Study (Meridian Service Company)
An 11‑employee firm moved from an aging fully‑insured group plan to ICHRA with role‑based allowances. Employees selected plans aligned to their doctors and medications; employer costs stabilized; HR workload dropped thanks to the reimbursement platform and clear documentation.
FAQs
- Can we keep HSAs with QSEHRA/ICHRA?
- Yes, alongside compatible plan designs; we’ll confirm details.
- How hard is substantiation?
- The platform handles receipts and privacy; we set thresholds and audits.
- Can we switch back to group later?
- Yes—review at renewal. Some employers pilot ICHRA with one class first.
Next Steps
Ask for a two‑scenario analysis (QSEHRA vs ICHRA). We’ll map total employer cost, compliance steps, and employee experience so you can choose confidently.
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