QSEHRA Eligibility & Design

Determine QSEHRA eligibility and model annual allowance scenarios for small employers under 50 FTEs.

Created by Corry Hull, REBC®, CSFS® for Employer Benefits IQ.

1.How thoroughly have you verified your eligibility for a QSEHRA — fewer than 50 ALE employees and no group health plan offered to any employee?

QSEHRAs are only available to employers that are not ALEs and do not offer a group health plan to any employee class.

2.How well does your QSEHRA allowance design reflect the 2026 annual limits ($6,450 self-only / $13,100 family) and differentiate by coverage tier?

Allowances cannot exceed the statutory limits. Employers may offer different amounts for self-only vs. family coverage.

3.How well do you comply with QSEHRA notice requirements, including the 90-day advance notice and annual notice rules?

Written notice must be provided at least 90 days before the plan year and to new hires within 90 days of eligibility.

4.How clearly do you communicate the premium tax credit coordination rules to employees receiving a QSEHRA?

Employees must reduce their PTC by the QSEHRA allowance amount. Failure to report can result in employee tax liability.

5.How effectively is your QSEHRA administered, including substantiation, eligible expense guidance, and COBRA continuation?

QSEHRAs require written plan documents and proper claims substantiation. COBRA continuation applies.

This tool provides educational decision support only. Results are not legal, tax, actuarial, or insurance advice. Validate all outputs against current plan documents, applicable law, and qualified professional guidance. Scoring version 1.0 · Reference year 2026.