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Start by identifying the arrangement—not by relying on the label “Section 105(b) plan.” Section 105(b) is a federal tax exclusion for qualifying reimbursements of incurred medical care expenses; it is not a complete plan design and does not make every employer health payment lawful or tax-free. An employer should evaluate the arrangement’s eligible expenses, claim substantiation, Section 105(h) nondiscrimination exposure, ACA treatment, notices, and reporting in light of the actual written plan and workforce.
What Section 105(b) does—and what it does not do
Section 105(b) can exclude from an employee’s gross income amounts paid to reimburse expenses for medical care, as defined by Section 213(d), subject to the statutory requirements. The reimbursement must be for care that has actually been incurred. A fixed allowance paid regardless of whether the employee incurred an eligible expense does not become an excludable reimbursement simply because the employer calls it a health benefit.
The distinction is important: Section 105(b) supplies a tax rule, not a universal plan blueprint. A written plan may narrow which eligible medical expenses it will reimburse, but listing an item in the plan cannot turn a nonmedical expense into qualifying medical care. Nor does satisfying the tax rule by itself establish that the arrangement complies with the Affordable Care Act (ACA), applicable notice rules, or other requirements that may apply.
In Internal Revenue Bulletin 2003-21, the IRS explains that claims must be substantiated to establish that a payment reimburses an eligible, actual expense. It also warns that procedures that do not specifically limit payments to eligible medical expenses do not meet Section 105(b)’s requirements. Employers should therefore evaluate the arrangement as both a tax design and an operating system for controlling payments.
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Identify the arrangement before evaluating it
“HRA” can refer to arrangements with different coverage structures and legal conditions. First determine what the employer has adopted—or is proposing to adopt—and compare that design with the coverage it offers and the expenses it intends to reimburse.
| Arrangement | Coverage structure or defining condition | Evaluation focus |
|---|---|---|
| HRA integrated with group coverage | Designed to operate with employer group health coverage under applicable integration rules. | Confirm the group coverage and the HRA meet the conditions for the intended integration. |
| Individual coverage HRA (ICHRA) | May be designed to reimburse eligible expenses in connection with individual health insurance coverage or Medicare under applicable rules. | Check the coverage conditions, monthly substantiation, participant notice, and premium tax credit implications. |
| Excepted benefit HRA | A limited category of HRA with its own conditions. | Verify that the arrangement meets the specific excepted-benefit conditions; do not treat the category as a general alternative to other HRAs. |
| Qualified small employer health reimbursement arrangement (QSEHRA) | An eligible employer generally must not offer a group health plan. The arrangement is employer-funded and reimburses eligible expenses after proof of coverage, subject to statutory conditions. | Confirm employer eligibility, coverage proof, written terms, and current-year requirements. |
| Other reimbursement arrangement | May not qualify as one of the named HRA designs. | Analyze its actual terms and operation rather than assuming that an HRA label supplies ACA compliance. |
The IRS overview of HRAs and its employer guidance on QSEHRAs describe these different conditions. A comparison should be based on the arrangement’s legal structure, not just whether it reimburses premiums or other health expenses. For example, a premium reimbursement arrangement is not automatically an ICHRA simply because employees buy individual coverage.
Check which expenses the plan actually reimburses
Read the plan document and administration rules together. List the expense categories the employer intends to reimburse, then check whether each category is eligible medical care under Section 213(d) and permitted by the plan’s terms. A plan can be narrower than the tax code’s eligible-expense definition; it cannot expand that definition by declaring a nonmedical purchase eligible.
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Ask how the plan treats premiums, services, products, and expenses paid by another source. Make sure the plan’s rules and claim process distinguish a reimbursement of an employee’s actual expense from a general payment that is available whether or not the expense occurred. The terms should also make clear what documentation establishes the expense and how the administrator handles a claim that does not meet the plan’s criteria.
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Do not assume every health-related item qualifies or that every HRA may reimburse every expense on the same basis. The answer depends on the expense, the applicable plan design, and the written plan terms. Have a qualified benefits or tax adviser review uncertain categories before the employer promises reimbursement.
Test claim substantiation before money is paid
Substantiation is a control over each reimbursement, not a general estimate that most claims are probably eligible. The IRS states in Internal Revenue Bulletin 2003-21: “Therefore, to ensure that a particular payment is a reimbursement of a medical expense, all claims for expense reimbursements must be substantiated.” The bulletin describes procedures that validate each claim and contrasts them with sampling that leaves some claims unverified.
Map the claim from submission to payment. For each type of claim, determine who checks it, which records are required, how the reviewer confirms the service or item, the date incurred, the amount, and whether the expense fits the plan. Then identify how the administrator detects duplicate submissions or expenses already reimbursed elsewhere.
- Evidence: Define the documentation or reliable transaction information needed to establish the expense and its amount.
- Review: Confirm that every claim is subject to an appropriate validation process before payment, rather than relying on a sample of claims.
- Timing: Check that the expense has been incurred and that the claim is submitted and paid under the plan’s procedures.
- Records: Establish how claim evidence and decisions are retained so the employer can explain why a payment was made.
- Exceptions: Specify how incomplete, ineligible, duplicate, or otherwise questionable claims are held, denied, or escalated.
Some electronic workflows can support substantiation when they use reliable transaction data and appropriate review or receipts. Automation does not, by itself, prove that every expense is eligible; the employer should understand what information the workflow actually validates and what it leaves to manual review.
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For ICHRAs, verify coverage as well as expenses
ICHRA administration involves a separate coverage check in addition to substantiating the reimbursed expense. The IRS’s 2019 final-rule materials describe initial and ongoing substantiation of required individual coverage or Medicare enrollment. Under those rules, an expense may not be reimbursed for a month unless the required coverage for that month is substantiated. Confirm that the administrator’s process checks the coverage condition for the relevant month rather than treating a one-time enrollment record as proof for every later month.
Assess Section 105(h) nondiscrimination exposure
For a self-insured medical reimbursement plan within Section 105(h), review both eligibility and benefits under the applicable nondiscrimination rules. The analysis is not reduced to asking whether every employee receives the same dollar amount: the relevant tests depend on the plan category and detailed statutory and regulatory rules.
The IRS’s discussion in Internal Revenue Bulletin 2019-42 explains that highly compensated individuals may lose the Section 105(b) exclusion for excess reimbursements if the applicable tests are failed. It also distinguishes premium-only arrangements from arrangements that reimburse other medical expenses. Classify the plan before applying a rule, and review who can participate, which employee classes are covered, and whether benefits are offered and provided on terms that satisfy the requirements for that plan.
Keep the eligibility and benefit review tied to real workforce facts, including the written classes and how the plan operates in practice. If the employer changes eligibility, reimbursement categories, or the workforce, have the analysis revisited rather than assuming that a prior review still applies.
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Screen ACA integration and employer-payment-plan risk
Do not treat reimbursement of individual policy premiums as automatically compatible with ACA market reforms. The IRS guidance on employer health care arrangements describes a stand-alone employer payment plan that reimburses individual policy premiums as a group health plan subject to those reforms; it states that this type of plan cannot be integrated with individual policies to satisfy them.
That arrangement must be distinguished from an ICHRA or another HRA design that is expressly permitted to integrate with individual health insurance coverage or Medicare when its conditions are met. Identify the arrangement first, then verify its current integration requirements against the plan terms and how it is administered. Calling a payment a Section 105(b) reimbursement does not resolve the ACA question.
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For an ICHRA, review the participant notice as part of the plan design, not as a last-minute administrative step. The IRS’s 2019 final-rule materials describe notice content covering plan terms, available amounts, coverage requirements, and possible premium tax credit consequences. Confirm the current notice requirements and timing against the governing rules and the actual plan before distributing materials.
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Use a practical employer review sequence
- Inventory the offer. Gather the signed plan document, summaries, administrative procedures, employee communications, and any existing group coverage. Record what the employer promises to reimburse and who is eligible.
- Classify the design. Decide whether the arrangement is an integrated HRA, ICHRA, excepted benefit HRA, QSEHRA, or another employer payment arrangement. Confirm that the label matches the terms and actual operation.
- Map expenses to the rules. Compare each intended expense category with Section 213(d) and the plan’s own limits. Remove or revise categories that cannot be supported as eligible under both.
- Walk through a sample claim process. Trace the evidence, review, decision, and payment controls for each claim type. For ICHRAs, trace the required coverage check for each relevant month as well.
- Review workforce treatment. Identify participant classes and benefit terms, then have the Section 105(h) analysis performed where applicable.
- Check ACA, notice, and reporting obligations. Evaluate integration based on the actual design, confirm required participant communications, and identify applicable tax-year reporting duties.
- Document decisions and assign ownership. Record who maintains plan terms, reviews claims, handles exceptions, prepares notices, and monitors reporting. Revisit those responsibilities when the design or workforce changes.
Common warning signs and what to do next
- Payments are made without receipts or equivalent claim-level validation. Pause and review the payment process with the plan administrator and qualified advisers. Determine which claims were not substantiated and what corrective steps are appropriate under the plan and applicable rules.
- Employees receive a set cash amount regardless of expenses. Reassess whether the arrangement is truly a reimbursement plan. A health-benefit label does not establish the Section 105(b) exclusion for unconditional payments.
- Individual premiums are reimbursed through a stand-alone arrangement. Review the ACA treatment promptly; do not assume individual policies make the employer arrangement integrated.
- The HRA name is known, but its category is not. Stop relying on a generic label and classify the design before making claims about eligibility, coverage, or compliance.
- A prior-year limit or filing procedure is being reused. Check the current tax-year materials and applicable annual requirements before relying on old figures or instructions.
These are review triggers, not a substitute for a plan-specific legal conclusion. A correction can depend on the plan’s terms, what was paid, when it was paid, and the applicable rules; employers should get advice before attempting to change or recoup benefits.
When professional review is necessary
The right answer depends on the written terms, employer and workforce facts, existing coverage, and intended expenses. The federal IRS materials discussed above do not resolve every question involving state law, ERISA, insurance regulation, or other agency guidance. Have qualified benefits, tax, and legal advisers review the design and operating procedures, particularly before launch, after a material plan change, or when an audit reveals unsubstantiated payments or uncertain ACA treatment.
For a decision-ready review, give advisers the plan document, claim workflow, coverage details, participant classes, employee notices, and reporting history. That lets them evaluate the arrangement that employees actually receive rather than a label or summary alone.
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