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The plan sets eligibility and enrollment requirements, establishes benefit reimbursement rules and annual limits, and describes payment administration, claims handling, and participant responsibilities. It also covers plan administration, amendment and termination rights, legal compliance, and notices, including required federal marital-status determinations for spousal benefits.","_________________________\nQualified Small Employer Health Reimbursement Arrangement\nEffective ________________, 20__\nTHIS IS A TEMPLATE QSEHRA DOCUMENT THAT CAN BE USED BY SMALL EMPLOYERS WHO WANT TO REIMBURSE EMPLOYEES’ INDIVIDUAL HEALTH INSURANCE POLICY PREMIUMS. BRETHREN BENEFIT TRUST RECOMMENDS YOU CONSULT WITH YOUR TAX OR LEGAL ADVISOR BEFORE ADOPTING THIS PLAN.\nTABLE OF CONTENTS\nPage\n\u0013 TOC \\f \\o 1-2 \\* MERGEFORMAT \u0014ARTICLE I DEFINITIONS\t\u0013 PAGEREF _Toc486514250 \\h \u00142\u0015\nClaim Administrator\t\u0013 PAGEREF _Toc486514251 \\h \u00142\u0015\nCode\t\t\u0013 PAGEREF _Toc486514252 \\h \u00142\u0015\nDependent\t\u0013 PAGEREF _Toc486514253 \\h \u00142\u0015\nEffective Date\t\u0013 PAGEREF _Toc486514254 \\h \u00142\u0015\nEligible Employee\t\u0013 PAGEREF _Toc486514255 \\h \u00142\u0015\nEmployer\t\u0013 PAGEREF _Toc486514256 \\h \u00142\u0015\nEnrollment Form\t\u0013 PAGEREF _Toc486514257 \\h \u00142\u0015\nHealth Care Expense\t\u0013 PAGEREF _Toc486514258 \\h \u00143\u0015\nHRA Account\t\u0013 PAGEREF _Toc486514259 \\h \u00143\u0015\nParticipant\t\u0013 PAGEREF _Toc486514260 \\h \u00143\u0015\nPeriod of Coverage\t\u0013 PAGEREF _Toc486514261 \\h \u00143\u0015\nPlan\t\t\u0013 PAGEREF _Toc486514262 \\h \u00143\u0015\nPlan Administrator\t\u0013 PAGEREF _Toc486514263 \\h \u00143\u0015\nPlan Year\t\u0013 PAGEREF _Toc486514264 \\h \u00144\u0015\nSpouse\t\t\u0013 PAGEREF _Toc486514265 \\h \u00144\u0015\nARTICLE II ELIGIBILITY AND ENROLLMENT\t\u0013 PAGEREF _Toc486514266 \\h \u00145\u0015\n2.01\tEligibility\t\u0013 PAGEREF _Toc486514267 \\h \u00145\u0015\n2.02\tEnrollment\t\u0013 PAGEREF _Toc486514268 \\h \u00145\u0015\nARTICLE III TERMINATION OF BENEFITS\t\u0013 PAGEREF _Toc486514269 \\h \u00146\u0015\n3.01\tTermination of Coverage\t\u0013 PAGEREF _Toc486514270 \\h \u00146\u0015\n3.02\tCoverage Following Termination of Employment\t\u0013 PAGEREF _Toc486514271 \\h \u00146\u0015\nARTICLE IV REIMBURSEMENT BENEFITS\t\u0013 PAGEREF _Toc486514272 \\h \u00147\u0015\n4.01\tProvision of Benefits\t\u0013 PAGEREF _Toc486514273 \\h \u00147\u0015\n4.02\tContributions and Funding\t\u0013 PAGEREF _Toc486514274 \\h \u00147\u0015\n4.03\tLimitations on Reimbursements and Forfeitures\t\u0013 PAGEREF _Toc486514275 \\h \u00147\u0015\n4.04\tAnnual Limits\t\u0013 PAGEREF _Toc486514276 \\h \u00148\u0015\n4.05\tNo HRA Account Carryover\t\u0013 PAGEREF _Toc486514277 \\h \u00148\u0015\n4.06\tExpense Reimbursement Procedure\t\u0013 PAGEREF _Toc486514278 \\h \u00148\u0015\n4.07\tCoordination with Other Sources, Including Flexible Spending Accounts\t\u0013 PAGEREF _Toc486514279 \\h \u00149\u0015\n4.08\tImpact on Premium Tax Credits\t\u0013 PAGEREF _Toc486514280 \\h \u00149\u0015\nARTICLE V PAYMENT OF BENEFITS\t\u0013 PAGEREF _Toc486514281 \\h \u001410\u0015\n5.01\tApplication for Benefits\t\u0013 PAGEREF _Toc486514282 \\h \u001410\u0015\n5.02\tAssignment of Benefits\t\u0013 PAGEREF _Toc486514283 \\h \u001410\u0015\n5.03\tPayment to Representative\t\u0013 PAGEREF _Toc486514284 \\h \u001410\u0015\n5.04\tResponsibility for Payment\t\u0013 PAGEREF _Toc486514285 \\h \u001410\u0015\n5.05\tOverpayments\t\u0013 PAGEREF _Toc486514286 \\h \u001410\u0015\n5.06\tParticipant’s Responsibilities\t\u0013 PAGEREF _Toc486514287 \\h \u001411\u0015\n5.07\tMissing Person\t\u0013 PAGEREF _Toc486514288 \\h \u001411\u0015\n5.08\tFraudulent Claims\t\u0013 PAGEREF _Toc486514289 \\h \u001411\u0015\nARTICLE VI ADMINISTRATION OF THE PLAN\t\u0013 PAGEREF _Toc486514290 \\h \u001412\u0015\n6.01\tAdministration of the Plan\t\u0013 PAGEREF _Toc486514291 \\h \u001412\u0015\n6.02\tAppointment of Claim Administrator\t\u0013 PAGEREF _Toc486514292 \\h \u001412\u0015\n6.03\tPowers of the Plan Administrator\t\u0013 PAGEREF _Toc486514293 \\h \u001412\u0015\n6.04\tClaims Procedure\t\u0013 PAGEREF _Toc486514294 \\h \u001413\u0015\n6.05\tRecords and Reports\t\u0013 PAGEREF _Toc486514295 \\h \u001414\u0015\n6.06\tLimitation on Liability\t\u0013 PAGEREF _Toc486514296 \\h \u001414\u0015\n6.07\tIndemnification\t\u0013 PAGEREF _Toc486514297 \\h \u001414\u0015\n6.08\tNotice\t\u0013 PAGEREF _Toc486514298 \\h \u001415\u0015\nARTICLE VII DURATION AND AMENDMENT OF THE PLAN\t\u0013 PAGEREF _Toc486514299 \\h \u001416\u0015\n7.01\tRight to Amend\t\u0013 PAGEREF _Toc486514300 \\h \u001416\u0015\n7.02\tRight to Terminate\t\u0013 PAGEREF _Toc486514301 \\h \u001416\u0015\nARTICLE VIII MISCELLANEOUS\t\u0013 PAGEREF _Toc486514302 \\h \u001417\u0015\n8.01\tEffect on Employment\t\u0013 PAGEREF _Toc486514303 \\h \u001417\u0015\n8.02\tEffect on Benefits\t\u0013 PAGEREF _Toc486514304 \\h \u001417\u0015\n8.03\tLegal Compliance\t\u0013 PAGEREF _Toc486514305 \\h \u001417\u0015\n8.04\tGoverning Law\t\u0013 PAGEREF _Toc486514306 \\h \u001417\u0015\n8.05\tNo Guarantee of Tax Consequences\t\u0013 PAGEREF _Toc486514307 \\h \u001417\u0015\n8.06\tInvalid Provisions\t\u0013 PAGEREF _Toc486514308 \\h \u001418\u0015\n\u0015\nINTRODUCTION\nThe __________________________ Qualified Small Employer Health Reimbursement Arrangement (the “Plan”) was established to provide eligible employees (“Employees”) of _______________","cbCaiuKFYFoC690D","https://ap.wps.com/l/cbCaiuKFYFoC690D","docx",65686,21,"English","en",105,"# ARTICLE I DEFINITIONS\n## Claim Administrator\n## Code\n## Dependent\n## Effective Date\n## Eligible Employee\n## Employer\n## Enrollment Form\n## Health Care Expense\n## HRA Account\n## Participant\n## Period of Coverage\n## Plan\n## Plan Administrator\n## Plan Year\n## Spouse\n# ARTICLE II ELIGIBILITY AND ENROLLMENT\n## 2.01 Eligibility\n## 2.02 Enrollment\n# ARTICLE III TERMINATION OF BENEFITS\n## 3.01 Termination of Coverage\n## 3.02 Coverage Following Termination of Employment\n# ARTICLE IV REIMBURSEMENT BENEFITS\n## 4.01 Provision of Benefits\n## 4.02 Contributions and Funding\n## 4.03 Limitations on Reimbursements and Forfeitures\n## 4.04 Annual Limits\n## 4.05 No HRA Account Carryover\n## 4.06 Expense Reimbursement Procedure\n## 4.07 Coordination with Other Sources\n## 4.08 Impact on Premium Tax Credits\n# ARTICLE V PAYMENT OF BENEFITS\n## 5.01 Application for Benefits\n## 5.02 Assignment of Benefits\n## 5.03 Payment to Representative\n## 5.04 Responsibility for Payment\n## 5.05 Overpayments\n## 5.06 Participant’s Responsibilities\n## 5.07 Missing Person\n## 5.08 Fraudulent Claims\n# ARTICLE VI ADMINISTRATION OF THE PLAN\n## 6.01 Administration of the Plan\n## 6.02 Appointment of Claim Administrator\n## 6.03 Powers of the Plan Administrator\n## 6.04 Claims Procedure\n## 6.05 Records and Reports\n## 6.06 Limitation on Liability\n## 6.07 Indemnification\n## 6.08 Notice\n# ARTICLE VII DURATION AND AMENDMENT OF THE PLAN\n## 7.01 Right to Amend\n## 7.02 Right to Terminate\n# ARTICLE VIII MISCELLANEOUS\n## 8.01 Effect on Employment\n## 8.02 Effect on Benefits\n## 8.03 Legal Compliance\n## 8.04 Governing Law\n## 8.05 No Guarantee of Tax Consequences\n## 8.06 Invalid Provisions","[{\"question\":\"What reimbursement does this QSEHRA template cover?\",\"answer\":\"It provides reimbursement of certain health care expenses, including reimbursement of individual health insurance policy premiums for an employee and eligible dependents up to limits set by the employer or required by law.\"},{\"question\":\"Who is eligible to participate and receive benefits?\",\"answer\":\"Participation requires enrollment in the plan. Eligibility and enrollment rules are defined in Article II, and spousal benefits follow federal law requirements for marital status under the plan.\"},{\"question\":\"How are reimbursement claims processed and paid?\",\"answer\":\"The plan describes the expense reimbursement procedure, an application process for benefits, and responsibilities for participants. It also covers claims procedure, administration, and rules addressing overpayments and fraudulent claims.\"}]","Qualified Small Employer Health Reimbursement Arrangement - Template | DOCX",1788239055,7,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":14,"keywords":34,"description":15,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"qualified-small-employer-health-reimbursement-arrangement-template","",{"@graph":36,"@context":85},[37,54,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":11},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/template/","Template",2,{"item":49,"name":13,"@type":43,"position":50},"https://docshare.wps.com/template/forms/",3,{"item":52,"name":14,"@type":43,"position":53},"https://docshare.wps.com/template/qualified-small-employer-health-reimbursement-arrangement-template/168871/",4,{"url":52,"name":14,"@type":55,"author":56,"headline":14,"publisher":58,"fileFormat":61,"inLanguage":23,"description":15,"dateModified":62,"datePublished":62,"encodingFormat":61,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-01",true,{"@type":65,"interactionType":66,"userInteractionCount":11},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"What reimbursement does this QSEHRA template cover?","Question",{"text":75,"@type":76},"It provides reimbursement of certain health care expenses, including reimbursement of individual health insurance policy premiums for an employee and eligible dependents up to limits set by the employer or required by law.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"Who is eligible to participate and receive benefits?",{"text":80,"@type":76},"Participation requires enrollment in the plan. Eligibility and enrollment rules are defined in Article II, and spousal benefits follow federal law requirements for marital status under the plan.",{"name":82,"@type":73,"acceptedAnswer":83},"How are reimbursement claims processed and paid?",{"text":84,"@type":76},"The plan describes the expense reimbursement procedure, an application process for benefits, and responsibilities for participants. 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