Can my employer pay for my health insurance coverage?


An employer can't pay for a plan an employee choses if they have to comply with the employer mandate, but can reimburse a group plan. Employers can't "use healthcare arrangements to satisfy market reforms by reimbursing employees for individual health plans" in general, but those who don't have to comply with the mandate can look into carefully structured section 105 workarounds as described in the link below (it is too complex a subject for a simple answer).

The general intent of this rule is to ensure that employers don't simply have employees shop on the Marketplace with subsidies and reimburse them (using tax payer funded subsidies to skirt their employer responsibility).

A large employer should offer a health sharing arrangement with a group health plan. A small employer won't get hit with a fee for misunderstanding this rule, but they still should make sure they are complying with the rules correctly moving forward (that means offer a group plan unless you are very sure you know what you are doing with a section 105 plan).

You can read about the rules for employer health care arrangements like Employer payment plans and HRAs here.

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Ray Schwabenbauer on

Answer Rating:

If I cant reimburse and I cant afford good health care from Highmark/UPMC…what is my options so our employees are covered. Highmark is forcing the small company out for what ever reason….what are my options? on

All businesses with less than 100 FTE can start using the SHOP marketplace for group coverage. Smaller businesses can get tax breaks. In theory the SHOP helps avoid businesses from getting swindled by health brokers looking to extort small businesses who lack the buying power of larger firms.

alston on

can an employer pay for medical insurance that is the employer offers the employee . for instance an employee is out on w/c injury and cant afford the premium that was coming out of his check, can the employer pay it . on

The employer can’t pay an employee premium directly. 100% bottom line. The payment will be rejected if it comes from a business account. An employer has to provide compensation, and then the employee can use that compensation to pay the premium. That said, employers can use different methods of compensation, but this gets into heady business law stuff.

Roxanne on

This tells me nothing about small businesses. Can a small business – one not required to provide health insurance because it has fewer than 50 FTE employees – reimburse or partially reimburse an employee for their ACA premium? on

I updated the answer. The general answer is generally it is best to offer a group plan, however ZaneBenefits has been suggesting a “carefully structured” section 105 plan. Documentation over the years suggests Zane is right, but we’ve been erring on being neutral in the discussion. You can learn more here:

Bri on

My employer is reimbursing my coworker every month for her $300 medical insurance under covered california. He has not offered this to me or an other type of insurance even though i have asked. Is this legal for him to do? on

Yes, it can be. It has to do with how many hours you work over what time period (measurement periods).