health benefit options for nannies

Health Benefits for Nannies and Other Household Employees

Looking for ways to offer health care benefits to your nanny or other household employees? Here are some affordable, tax-friendly options to consider. Offering health benefits is a great way to attract the best talent to your position and retain your top employees.

These health plans are better choices for you and your employee rather than giving them money or a stipend. Pre-tax plans reduce an employee’s taxable wages lowering your and your worker’s tax obligations. Stipends can be considered taxable income.

GTM Payroll Services can administer a plan for you and tie it into your payroll service to make health care coverage easy for you and your employee. Call (800) 929-9213 with any questions or to get started.

Concierge Medicine

With a concierge medicine service, your employee will have 24/7 access to a physician by phone, secure messaging or video even if they don’t have health insurance. They can get answers to simple or complex medical questions, schedule a consult, and share pictures or videos with a doctor. It’s perfect for diagnosing and treating everyday ailments like colds, allergies, rashes, injuries, and more. The concierge medicine service can also send prescriptions directly to your employee’s pharmacy when appropriate. Concierge medicine just $12/month. Learn more about concierge medicine.

Flexible Spending Accounts (FSA)

An FSA can be used for employee out-of-pocket medical, dental, and vision care expenses that are not covered by other insurance. FSAs can be funded by the employee, employer or both parties can contribute to the account. However the FSA is funded, up to $2,700 in pre-tax dollars can be used to cover qualified expenses.

An FSA lowers your employee’s taxable wages, reducing your tax obligation by 7.65 percent (your employer contribution to an employee’s Social Security and Medicare accounts) of the funds placed in an FSA.

You would offer the FSA and designate an open enrollment period where your employee can determine the amount of money they expect to spend on healthcare items for the upcoming year. That amount will be divided into regular payroll deductions and allocated to their FSA account.

To be reimbursed from their FSA account, your employee would submit receipts for qualifying medical expenses. FSA funds can cover vision expenses, prescription drugs, orthodontic procedures, dental charges, X-rays, blood work, health plan deductibles and co-pays, chiropractic charges, and other medical-related expenses.

Health Savings Accounts (HSA)

Funds in an HSA can be used to cover deductibles in a high-deductible health care plan and out-of-pocket medical, dental, and vision expenses. HSAs can be funded by the employee and/or employer. Money contributed to an account is either pre-tax or tax-deductible depending on how it is set up. An HSA is the only plan that is individually owned by the employee so they can remain with a worker even if they change jobs. Because of this portability and the rollover of funds from year to year, an HSA can be used to cover medical expenses when the employee is in retirement.

2019 HSA Limits

  Individual Family
HSA Contribution Limit $3,500 $7,000
Minimum Annual Deductible $1,350 $2,700
Maximum Out-of-Pocket Amounts $6,750 $13,500
Maximum Catch-up Contributions (age 55 and older) $1,000 N/A

Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)

A QSEHRA allows employers with less than 50 employees to offer a Health Reimbursement Arrangement. It’s a great option for household employers who don’t offer a full health insurance plan for their employees. Under a QSEHRA, employees are reimbursed for health insurance plans purchased on the individual market or through the Affordable Care Act health care exchange. They can also be paired with an employee’s spouse’s plan. A QSEHRA can also be used for out-of-pocket medical, dental, and vision expenses. They are employer-funded and tax-free for your employee.

Annual employer contributions to a QSEHRA are capped at $5,150 for an employee who is single and $10,450 for an employee with a family.

Employers are not allowed to offer health insurance to their employees if they want to provide a QSEHRA.

As an employer, you can allow unused account balances to roll over into the next plan year.

All employees are eligible but may be excluded if they are requesting family coverage, under 25-years old, part-time, seasonal or have less than 90 days of employment.

Health Reimbursement Arrangement (HRA)

An HRA is paired with a standard group health insurance plan that you offer to employees. HRAs are employer-funded only and you must have at least two employees in order to offer them. An employee can use an HRA for insurance premiums and/or out-of-pocket expenses. Annual contributions are capped at $5,150 for an employee who is single and $10,450 for an employee with a family. Unused account balances can roll over into the next plan year.

Premium-only Plan (POP)

A POP is paired with a group plan and allows employees to purchase health insurance and other benefits tax-free. Since their health care premium is deducted pre-tax, your employee will realize reductions on their income tax obligation and FICA (Social Security and Medicare) contributions. The employer will also see savings in their contribution to their employee’s FICA accounts.

Health Benefit Options Comparison Chart

This chart will help you compare the various plans and select one that will best meet the needs of your employee.

  FSA HRA HSA QSE-HRA POP
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 $2,700 $5,150 single
$10,450 family
$3,500 single
$7,000 family
$5,150 single
$10,450 family
No limit
Pairings N/A Group plan High-deductible plan Individual plans Group plan
Coverage restrictions None Must cover at least two employees None None None

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