how to set up a qsehra for your nanny

QSEHRA for a Nanny

QSEHRA stands for Qualified Small Employer Health Reimbursement Arrangement. Employers with less than 50 employees (qualified small employers or QSEs) can offer Health Reimbursement Arrangements (HRA) to their employees. While you are not allowed to offer a QSEHRA and a group insurance plan, QSEHRAs can:

  • reimburse your nanny for health insurance coverage purchased on the individual market or through the health care exchange
  • be paired with an employee spouse’s plan
  • be used for out-of-pocket medical, dental, and vision expenses.

QSEHRAs are funded by the employer up to $6,150 for a nanny who is single and $12,450 per employee with a family (2024 contribution rates).

Advantages of a QSEHRA for a Nanny

  • Employer contributions to a nanny’s account are not taxed for you or your employee. Reimbursements are also not taxed as long as your nanny has a health plan that meets minimum essential coverage (MEC).
  • Reimbursements may be made immediately when your nanny becomes eligible to participate.
  • Nannies can purchase the health plan they want
  • Employers can set the budget and include waiting periods
  • Funds can carry over from year to year if allowed by the employer. An employee’s total benefit can’t exceed the annual contribution limit.

Employee Requirements

Nannies must purchase a health plan that has minimum essential coverage (MEC), as stated by the Affordable Care Act (ACA). If your nanny purchases health coverage that doesn’t qualify as MEC, they may be taxed and reimbursements from the QSEHRA may be included in their gross income.

Qualified health plans include: Marketplace plans, Medicare, Medicaid, CHIP, individual health plans with MEC (ask the insurance company if this plan matches a “qualified health plan”), retiree plans, and COBRA.

Unqualified health plans include: Coverage for vision care only, coverage for dental care only, workers’ compensation, coverage only for a specific disease or condition, and plans that only discount medical services.

Nannies who obtain health insurance through a public exchange and qualify for subsidized coverage (tax benefit towards the plan) must report the amount in the QSEHRA to the exchange. Their federal subsidy amount will be reduced by the amount of their benefit.

Employer Requirements

Your employer responsibilities include:

  • Having a Plan Document
  • Distributing a Summary Plan Description (SPD) within 90 days of your employee becoming a plan participant
  • Not sponsoring any other health, dental, or vision plan
  • Providing a QSEHRA to all eligible employees (if you have more than one employee) under the same terms and employees can’t waive participation in the QSEHRA
  • Providing all eligible employees with a written notice 90 days prior to the start of the plan year
  • Obtaining proof that employees have minimum essential coverage with each reimbursement and on an annual basis
  • Substantiating all reimbursement claims
  • Reporting the employee’s permitted benefits in box 12 of their Form W-2 using code FF

Health Insurance & Benefits Options Comparison Chart

This chart will help you compare the various plans and select one that will best meet the needs of your nanny. These are contribution rates for 2024.

Employer funded    
Employer tax savings
Employee funded      
Employee tax savings
Covers out-of-pocket expenses  
Covers insurance premiums      
Used to purchase health insurance          
Contribution limits $3,200 No limit $4,150 single
$8,300 family
$6,150 single
$12,450 family
No limit No limit
Pairings N/A Group plan High-deductible plan Individual plans N/A Group plan
Coverage restrictions None Must cover at least two employees None None None None

Get Started

Through our affiliate GTM Insurance Agency, setting up a QSEHRA for your nanny is easy and straightforward. Our insurance team will guide you through the entire process. Call (800) 929-9213 for more information or to get started.

Looking for some other health benefit ideas? Check out these options.

Talk to an Expert

Our employee benefits experts are available to discuss your needs and help you get started with a Health Reimbursement Arrangement or other benefits.

Call Us
(800) 929-9213
Mon – Fri 8:30 am – 8 pm ET

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