South Carolina Small Business Health Insurance Options

South Carolina Small Business Health Insurance Options

This is the HSA For America Complete Guide for South Carolina small business health insurance. This guide focuses primarily on South Carolina companies with 30 workers or less.
This document is designed to help small businesses, freelancers and independent professionals offer the most cost effective set of health benefits. You can remain competitive while providing the benefits, compensation and other incentives you need to retain and attract top talent.

South Carolina Small Business Health Insurance Benefits

South Carolina’s small businesses have several options to choose from when it concerns providing health benefits to their employees.

The first option, which is the most common but by far the most expensive, is to implement traditional group health plans.

Prices vary according to age. But, according data provided by the Kaiser Family Foundation for 2022, an employer-sponsored group insurance plan covering a family and a worker would cost on average $1,945 per year.

South Carolina workers typically pay more than $5,076, on average, towards their health insurance.

South Carolina businesses can also reduce their expenses by a great deal with a number of options. These include:

  • Health savings Accounts (HSAs).
  • Health reimbursement agreements (HRAs).
  • Direct primary care (DPC), memberships
  • Health Sharing Programs 

The best strategy to use for your South Carolina small business health insurance depends on several factors. This includes the size and budget of your business as well as the age of your staff and their dependents.

Read on the go, download our Complete Guide To Small Business Healthcare Plans.

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South Carolina Small Business Health Insurance Geographic Considerations

South Carolina’s unique healthcare system is also important to consider. It includes urban areas like Greenville and Greenville as well rural areas in places like York, Barnwell, and Columbia.

South Carolina businesses should carefully consider the distribution of their staff across the state. It’s not a good idea for Greenville-based executives to choose a HMO that only allows workers to see doctors within the plan network. Many of these employees and their families work and live outside of this network. 

South Carolina Small Business Group Health Insurance

For most South Carolina businesses, the traditional group health plan is their preferred choice.

It is also the most costly.

Here’s what it looks like:

The employer will contract with a third party insurance provider, which is usually a corporation that makes money. This company will provide a package of benefits to workers and their families if they so desire.

Employers with 50 or greater employees are required to offer ACA qualified health insurance for all employees working more than 30 hours a week

The health plan must cover the 10 Minimum Essential Coverages (MEC) as required by Affordable Care Act. They are:

  • Ambulatory patient service (outpatient treatment you get without needing to be admitted in a hospital).
  • Emergency Services
  • Hospitalization is a term used to describe a hospital stay (e.g., overnight stays or surgery).
  • Pregnancy care, maternity care, and newborn (both before and afterwards)
  • Treatment for mental disorders and substance abuse, including counseling (and psychotherapy).
  • Prescription drugs
  • Rehabilitative or habilitative services or devices (services or devices to help those with chronic or severe disabilities or injuries gain mental or physical skills)
  • Laboratory services
  • Prevention and wellness services for chronic diseases management
  • Dental and vision services for adults are not included in essential health coverage.

The ACA also requires insurance companies to cover birth control, breastfeeding and other health services.

Although traditional health insurance is most expensive, it offers the benefit of guaranteed enrollment.

In the event that the employee enrolls before the end of the initial enrollment phase, during a period of special enrollment due to a qualifying life-event, or at the beginning of the open enrollment season, starting November 1st, the insurer cannot deny them coverage or charge a premium higher because of the medical history.

South Carolina Small Business Owners Can Choose Not To Have Health Insurance

In accordance with the Affordable Care Act employers employing fewer that 50 people are not obliged to provide any form of health insurance.

South Carolina has no requirements either. The state of South Carolina does not require employers with less than 50 workers to provide any type of health insurance.

You will not be penalized.

But it is a good idea to offer health care benefits to all companies, including small businesses. Without them it could be very difficult to find and keep quality employees.

South Carolina has a low unemployment rate and fierce competition amongst employers for talented employees.

South Carolina employers are able to save lots of money if they offer a medical sharing plan. 

The HRA Alternative

You can help your employees to pay for individual health insurance by offering a QSEHRA, which is a qualified small-employer health reimbursement arrangement.

QSEHRAs provide employers with the following benefits:

1.) No minimum contribution limit

QSEHRA doesn’t bind you to a certain minimum contribution each year like a traditional pension plan. As an employee, you can choose your own budget to cover HRA expenses and make changes as necessary each year.
With a QSEHRA you can manage your health benefit budget.

2.) Flexibility

You can offer your employees a different benefit based on whether they are married or have children. You can discriminate and offer a greater benefit for employees with families compared to single employees without dependents, reflecting the cost of buying health insurance for them.

3.) Both employees and employers are entitled to tax-free treatment

Your employer’s contributions are fully deductible by the IRS as compensation expenses. Contrary to cash compensation, employees do not have to pay taxes on QSEHRA benefits if they keep a plan with the minimum essential coverage specified in the Affordable Care Act. 

In this case, a QSEHRA would be a better option than simply providing a health care stipend to employees that can then be used for health insurance purchases or other expenses.

4. QSEHRAs Promote Employee Choice

A large number of traditional group health insurance policies limit employees from a wide range of backgrounds to just one or a few health insurance options.

Many of these are overpriced or unsuitable to workers because they were chosen by HR, company management and not by workers themselves.

QSEHRAs give workers and families more options, allowing them to find the plan that best suits their needs.

South Carolina Has Taxed the Employer-Provided Healthcare Coverage

As an employer, you can deduct the full amount of health insurance premiums paid as a cost to your business under federal and South Carolina State law. Additionally, the employee does not pay any tax on them.

Healthsharing plans offer lower overall costs. They are tax deductible for the employee. Employees must pay taxes on the amount of employer assistance paid to cover health sharing costs.

South Carolina Employer Group Health Insurance Coverage: What Are the Disadvantages?

Traditional group health plans for employers have many disadvantages that can be detrimental to both the employer and employee.

  • Cost

    As we mentioned above, the cost of health insurance is often crippling.

    Washington and Columbia’s government regulators have packed health insurance policies to the brim with requirements and mandatory coverages, many of which are unjustified for most workers. 

    For example, traditional medical insurance companies must price in coverage for drug and/or alcohol addictions, mental health care, and maternity services that many employees don’t require or want.

    This reduces their efficiency and costs. 

  • Inflexibility

    Group health plans are often a one size fits all approach that does not address the specific needs and budgets for employees. By their nature, employer-sponsored group insurance plans tend to only offer one or a few solutions. These may not be ideal for specific employees.

    In some cases workers are better off buying their plan on the market individually – possibly taking advantage a subsidy offered under the Affordable Care Act.

    These workers may also benefit from a cheaper health sharing plan. These innovative and affordable health insurance alternatives can be a good solution, especially for workers with no preexisting conditions. 

    More information on health sharing programs is discussed below.

  • Administrative burden
  • Manage a full-fledged healthcare benefit comes with substantial administrative costs. It includes managing documentation, ensuring compliance with plans, auditing them to make sure that no non-qualified persons are enrolled, and responding directly to staff questions. This is essential for ensuring the health insurance program in an organization runs smoothly.

    The plans can be a major burden for employers with a small headcount who cannot justify the cost of a dedicated HR team to administer the plan. 

    Businesses can use alternative strategies such as the Health Reimbursement Arrangements, or even health care stipends. 

    These alternative methods encourage workers buy their own health insurance via the Affordable care Act. The Affordable Care Act may offer subsidies to workers. It takes the employer completely out of the equation, which will reduce overhead and administrative costs.

South Carolina Health Sharing Plans

Small businesses in South Carolina can benefit from health sharing plans as an affordable and viable alternative to expensive health insurance.

Medical cost sharing plans are becoming a popular alternative to traditional group health plans for businesses in South Carolina. They offer a more affordable option than traditional plans. Companies can save up to half on their premiums by switching from traditional group health insurance plans to medical cost sharing. 

This means that South Carolina small business could save up to $10,000 per year on family coverage and $3,500 for single coverage for each employee.

These programs are a new way to fund healthcare. They allow companies to provide employees with high-quality care while keeping costs down. The premise behind health sharing programs is to share resources between a group or organization.

In health sharing programs, participants pay a fixed amount per year instead of paying insurance premiums.

Health Sharing Plans vs. Health Insurance

Health insurance is not the same as health sharing plans.

Healthsharing groups are associations of people who share medical costs. Health sharing ministries, unlike health insurance companies that are typically for-profit corporations are non-profit.

Mandatory Coverage

Health insurance plans do not have such requirements. Federal and state laws require that traditional health insurance policies include coverage for many items, which many people do not want or need. Health sharing organizations are not subject to the Ten Minimum Essential Coverage requirements.

For example, medical cost-sharing plans do not have to cover the costs of addiction treatment for those who don’t use drugs. They don’t have to pay for injuries caused by drunken driving.

Pre-existing conditions

Healthsharing plans can impose waiting times before they share costs for treating pre-existing medical conditions.

They also often impose waiting times for surgeries, except in the case of accidents and injuries that were not foreseen before the member enrolled.

These waiting periods help eliminate a lot of adverse selection and allow health sharing organizations to provide a fantastic set of benefits for a fraction the cost of a non-subsidized ACA qualified group health insurance plan or one purchased through the South Carolina online exchange.

Note that healthsharing plans do not qualify for subsidies as part of the Affordable Care act. The price savings are so large that even if you qualify for a subsidy depending on your circumstances, many people will still benefit by switching to a healthsharing plan.

Switching to health sharing is often more beneficial for South Carolina employers, since small group health plans do not qualify for a subsidy on premiums under the ACA.

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South Carolina Health Sharing and Network Restriction

Health sharing plans offer more choices when it comes time to choose healthcare providers than traditional managed care plans like HMOs or PPOs. These are the most popular group health insurance plans sponsored by employers.

Healthsharing organizations in South Carolina don’t restrict their patients to providers in the network in most cases. Health sharing plan members can choose any doctor or provider they want. Choosing the doctor of your choice is a right that people should have.

Does Your Business Need To Offer Health Sharing?

Each business is unique. It takes careful analysis to choose the best plan for your business, whether you’re looking at a healthsharing plan or a more traditional group health plan. 

It’s simple for South Carolina business owners to receive a complete case analysis with recommendations specific to their organization and employees. Simply make an appointment to meet with a Personal Benefits Manager licensed in South Carolina.

You can help yourself by preparing a staff census.

Most of the time, switching from health insurance to health sharing will save you thousands per employee. Health sharing is not recommended if your employees have pre-existing medical conditions.

Consultation and analysis are always free.

South Carolina Small Business Health Insurance Reimbursement

Employees can receive tax-free reimbursements for medical expenses through Health Reimbursement Arrangements.

Small South Carolina companies often simply do not offer group insurance. In South Carolina, many small business owners opt to create an HRA. With the HRA they provide their employees with the funds to pay for individual health coverage on the private market using pre-tax dollars.

Workers can then take advantage of the subsidies available, which further reduces the cost to the company.

The HRA can be used to pay out of pocket costs like prescriptions or durable medical equipment. HRAs are also tax-free.

When you offer an HRA as a replacement for formal group health coverage, employees have the option to pick and choose health plans that suit their individual needs.

Read more about Health Reimbursement Accounts (HRAs) for Small Businesses.

QSEHRAs is the HRA for Small Businesses

QSEHRA is a specific type of HRA for small businesses.

This benefit is available to companies with less than 50 full-time or equivalent employees, who do not have any group health plan.

Businesses are allowed to set their QSEHRA allowances maximums up to certain limits. South Carolina employers may contribute as much money as they want to their employees. Individual employees can pay up to $5850 (or $487.50 a month), and employees with families up to $11,800 (or $983.33 a month).

Employees can use the money to purchase insurance on their own via an online health insurance exchange website or through a Personal benefits manager, in the market for individual and family health coverage. It preserves their eligibility to receive a subsidy. They would not have received one under a group insurance plan that was paid for by the employer.

Employers can reimburse their employees either for the premiums alone or for both premiums and additional medical expenses.

QSEHRAs, Special Enrollment Periods and the QSEHRA

If you decide to replace your existing health insurance plan with an HRA and cancel the old one, then your employees qualify for Special Enrollment. This is a window of 60 days during which employees can buy their own ACA qualified insurance plan without medical underwriting. 

This will ensure that your employees’ coverage is not interrupted when you replace your group health insurance with a QSEHRA.

HRA Advantages

Health Reimbursement Arrangements have many benefits.

You can deduct the money spent on HRA benefits, and your employees will not pay any tax.

HRA funds are yours to keep until they’re actually distributed to employees. It is available as operating capital. It’s not necessary to have it deposited.

You have great flexibility when it comes to designing your own HRA benefits. This includes the expenses that you will reimburse.

If workers leave their company or become contractors, they do not lose their health insurance coverage. In the QSEHRA, workers own and control their insurance policies. Not the employee.

HRA Disadvantages

Not all workers are willing to take on the task of researching and selecting their own insurance plan. Some workers will need additional help to make the transition. 

You can get help from your HSA for America personal benefits manager if this happens. So that no worker is left out.

You can also call 800-913-0172 to schedule an appointment.

Learn more about the alternatives to employer-sponsored insurance in South Carolina.

The Direct Primary Healthcare Advantage

Direct Primary care plans (DPCs) are an alternative healthcare plan that’s growing in popularity throughout the US. Membership-based model. Your employees get as many visits that they need in exchange for a flat and affordable monthly fee.

DPC memberships start at $80 per month, making it a very affordable and attractive option to improve your health without copays.

DPC plans give members access to all routine primary, chronic and pre-ventive care services.

Direct Primary Care Practices provide a wide range of services, including:

  • Preventive care. DPC doctors are committed to preventive care and offer routine screenings, immunizations and checkups.
  • DPC Doctors treat injuries and illness that are acute, such as minor cuts, infections, skin diseases, and colds.
  • Chronic disease management. DPC doctors assist patients in managing chronic conditions such as hypertension, diabetes, arthritis and more. These doctors offer ongoing treatment, monitor patients, and adjust their plans of care as required.
  • Comprehensive physical exams. DPC doctors provide comprehensive physical exams that help assess health overall, identify possible risks, and offer personalized health recommendations.
  • Urgent care. DPC is often able to offer same-day, or the next-day, urgent care.
    The appointment system allows patients to be seen quickly for medical problems that are not emergencies.
  • Diagnostic services and Laboratory Services DPCs may perform or arrange a range of lab tests including blood work, urine testing, imaging (x-rays, ultrasounds), and ECGs.
  • Medication management. DPC Doctors can prescribe medications. Monitor their effectiveness. And make necessary adjustments. Additionally, DPC doctors provide medication education and counselling.
  • Mental health services DPC practices offer mental health as part of comprehensive care. DPCs may also refer their patients to mental health professionals for therapy or counseling.
  • Minor procedures. DPCs are equipped to carry out minor surgeries in their own offices.
  • Care coordination, referrals. DPC’s doctors coordinate and advocate for their patients, as well as with specialist hospitals and healthcare providers.

No insurance companies are involved so there aren’t any co-pays. A monthly subscription will cover all costs. So, workers with limited funds can receive immediate medical attention. Never again will workers have to avoid seeing their doctors because they cannot afford the deductible and co-pay.

If patients need additional coverage, they can opt for supplemental plans that include high-deductible health plans, accident plans or healthsharing plans. DPC offers routine healthcare as part of membership. Patients can select more cost effective coverage such as healthsharing plans instead of traditional health insurance.

Health Savings Accounts

HSAs are an excellent tool for helping workers to manage their medical bills and also to lower the premiums of workplace health insurance plans.

South Carolina residents and business owners need every tax incentive they can receive. The good news: employer contributions to employee Health Savings Accounts can be fully deducted from South Carolina Corporate Income Tax as a compensation expense.

HSAs enable individuals to put money aside for future medical needs before they pay taxes. HSAs allow both employees and their employers to contribute, up to a certain annual limit. This is updated by Congress each year to keep pace with the cost-of-living.

HSAs allow for tax-deferred investment growth and withdrawals that are used to pay qualified healthcare costs.

HSA Eligibility

Employees who want to enroll in an High Deductible Health Plan (HDHP) or benefit from employer pretax contributions must do so.

In 2023, an IRS-defined high-deductible health care plan is any plan that has a minimum $1,500 deductible for individuals or $3,000 deductible for families.

A HDHP can only have a maximum of $7,500 in annual out-of pocket expenses. (This includes deductibles, co-payments and co-insurance. This limit does NOT apply to services received outside the HDHP network.) 

Can I Combine HSAs and Health Sharing? 

There is only one major health plan that allows employees to contribute pre-tax money into their health savings accounts: the HSA SECURE plan. It’s available through HSA America.

HSA SECURE Plan allows you to combine the tax- and healthcare-saving benefits of a Health Savings Account with the cost savings of Healthsharing.

For your employees to be eligible, they must earn some money from their own business or self-employment.

HSA SECURE cannot be used by employees who are W-2. HSA SECURE could be an excellent option for your employee or spouse if they have their own small business, side hustle, or freelance job, and are in good physical health without any preexisting conditions.

As a small business, you may find that the HSA-SECURE Plan is a fantastic way to save money.

Your employees must enroll in HSA SECURE by themselves. If they have already enrolled and created an HSA you can make pretax contributions in their name up to the annual limits Congress sets every year.

Learn more about the HSA SECURE plan.

How Are South Carolina Small Business Health Insurance Benefits Taxed?

After you’ve learned a little bit about all the other options that are available to small business owners in addition to health insurance, we have a short table to explain how each one is taxed.

Plan Type Employer Workers
Traditional health insurance premiums Tax deductible. May qualify for a tax credit (see below) Non-taxable
HSA contributions Tax deductible Pre-tax, up to certain limits. No income limitations.
Health sharing costs Tax deductible as a compensation expense Taxable as ordinary W-2 income
Health reimbursement arrangements Tax deductible Benefits are non-taxable to the employee
HSA withdrawals N/A Withdrawals for qualified medical expenses are tax-free. Otherwise taxable as ordinary income.
A 20% penalty for non-qualified withdrawals applies up until age 65.
Direct primary care costs Tax deductible as a compensation expense Taxable to the employee


Take Care of All the South Carolina Small Business Health Insurance Levels in the Pyramid

As shown in the below diagram, a good package of employee benefits should cover all of the levels of the Employee Healthcare Pyramid, from preventive health care to primary care for early detection and maintenance of health issues, up until catastrophic events.

Care Pyramid for South Carolina Small Business Health Insurance

We list the most common insurance solutions for each of the levels in the Care Pyramid on the left.

While on the right is a list of a variety of alternatives, which are more cost-effective, to provide meaningful protection to employees in each level of the Pyramid.

A good plan will provide employees with solutions that are affordable at all three levels. No employee should be forced to wait or forgo care due to the cost of a co-pay, premium or coinsurance.

A Personal Benefits manager can assist you in creating a plan that is tailored to your employees’ needs. This plan will provide solutions at every level of the Care Pyramid, and often for a fraction the price of a group plan.

South Carolina Small Business Health Insurance Tax Credit

Small Business Health Care Tax Credit was passed with the ACA and allows certain small businesses to receive a federal credit of up to 50% of employee health insurance costs.

It is aimed at small businesses who have 25 employees or less and hire workers with lower wages.

Both for-profit and nonprofit businesses can claim this credit.

* Less than 25 employees with an average salary around $53,000 (excluding all owner salaries). The average salary of the business is calculated without including the owners. Also, the number is calculated using “full time equivalents”. This means that two employees working half-time would be equal to one employee who works full-time.

* Pay a minimum of half the cost of employee premiums;

* Offer coverage that meets the requirements of the Affordable Care act on the state exchange. (In South Carolina’s situation, is the federal website for the online insurance marketplace.

If an employer has more than 25 employees, or if the average salary is $53,000, then they will no longer be eligible for the tax credit.

How Can I Claim a Credit?

This credit is available on your tax return for the year with IRS Forms 8941 attached (tax-exempt businesses are required to file Form 990T even if otherwise not required).

You are not taxed on contributions made to your employee’s health coverage.

I Don’t Have To Pay Taxes for My Company This Year. Can I Still Claim My Tax Credit?

Yes. The tax credit can either be carried forward and used to offset the income tax liability for the previous year, or carried back to offset the liability over the next 20-year period.

The credit can be refunded if your business is tax exempt.

You can consult with your tax advisor to get the full details of the Small Business Health Care Tax Credit.

Combining South Carolina Small Business Health Insurance Strategies

Combining different health insurance programs can maximize your coverage.

Many employers find that by combining several healthcare packages, they can control their healthcare costs while still providing full coverage to all of their employees.

One cost-effective approach is to combine a Direct Primary Care plan (DPC) for normal primary health care with a low cost health sharing plan covering catastrophic events.

Comparing this strategy to the conventional group health insurance can make it more affordable, either for your business or your employees.Giving employees the option to sign up for either a health sharing plan (HSP) or purchase an individual health insurance policy, and giving them the opportunity to fund a Health Savings Accounts(HSAs), for those who select HDHP plans that qualify for HSAs, could give them greater flexibility, while potentially lowering costs.

What Should You Do Now?

The best way to proceed is to conduct a business health assessment. Schedule an appointment now.

You will be connected to an experienced HSA for America Personal Benefits Manager. He or she will discuss with you your workforce and family, your budget needs, the ability of your employees to contribute and any preexisting medical conditions. 

Several of our PBMs were successful business owners or entrepreneurs themselves. They are business owners themselves and know what it takes for you to be competitive. 

Can I provide both Health Insurance and Health Sharing at the same? 

Yes, both options can be offered side-by side. This allows employees to select the best plan for their needs.

You may not be able to maintain your group plan if you have too few employees participating in the plan. HRAs can be used to reimburse employees for their individual health insurance. The cost will be similar.

South Carolina Small Business Health Insurance – Frequently Asked Questions

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What is the Difference Between Health Insurance and Shared Cost Health Insurance for Small Businesses

Health insurance is the traditional plan of coverage offered by insurance companies. Members contribute to a fund to cover one another’s medical expenses.

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What are the waiting periods on pre-existing conditions for health sharing plans?

Yes, there may be a waiting period for certain healthsharing plans before coverage is provided. You should review the guidelines of your plan or speak to a Personal benefits manager for more details.

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Can South Carolina tax payers deduct employer contributions for HSAs?

Yes. South Carolina allows employers to deduct their contributions for employee HSAs from their state income tax.

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Do small businesses in South Carolina make sense to offer Direct Primary Care plans alongside other coverage options?

Combining DPC coverage with low-cost plans like health sharing can provide cost-effective and comprehensive healthcare solutions for small business and their employees.

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Can a South Carolina-based business claim the Small Business Health Care Tax Credit, even if there are no taxes due?

Even if the business does not owe any taxes for a given year, it can still carry back the Small Business Health Care Tax Credit to offset tax liabilities from the prior year.

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What is a Health Reimbursement Agreement (HRA) and how does this work?

HRAs reimburse employees’ qualified medical costs not covered by insurance plans. Employers determine which expenses are eligible for reimbursement and allocate funds accordingly.

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How do I know which health insurance plan and cost sharing option is right for my South Carolina small business?

Don’t do it alone. Speak to a Personal Benefits manager. They can provide a free analysis based upon your needs, budget and employee count. They can help you design an optimal plan to maximize the value of your employees’ benefits while controlling costs, and helping you stay competitive.

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What are the benefits of Health Savings Accounts for South Carolina employees?

HSAs enable individuals to save pre-tax dollars for future medical expenses. Employers and employees both can contribute to the HSA, which could provide tax advantages as well as potential savings in healthcare costs.

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Can employers in South Carolina contribute to HSAs for their employees?

Yes, employers can make contributions to HSAs for their employees. However, there are annual limits set forth by Congress.

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In South Carolina, are maternity benefits covered under health sharing plans?

South Carolina health insurance plans, as well as healthsharing plans, often include maternity care benefits that cover prenatal care and labor, postnatal care and other related services. Some health sharing plans may restrict cost-sharing for children born out of wedlock.


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Does South Carolina have a limit on the size of a business that can qualify for these programs?

QSEHRA is only for employers with fewer 50 employees. There are also other HRAs that you can use if your company has more than fifty employees. 

If you fail to comply with the ACA’s requirement, then you will be subject to a fine. Talk to your Personal Benefits Coordinator if you’re about to hire 50 full-time workers or the equivalent, as this could impact your plan design.

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How do I claim my Small Business Health Care Tax Credit

Tax credit claims can be made on Form 8941 of the IRS for businesses that make a profit, whereas tax-exempt businesses are required to file Form 990-T.

HSA for America doesn’t provide tax advice. Employers can consult their tax advisor to get the full details on how to claim the credit.

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Can HRAs used in conjunction with other insurance options such as individual health plans or health sharing plans?

HRAs may be used in conjunction with other options of coverage. HRAs are used by some small businesses to reimburse employees premiums for individual policies and cancel their group health insurance. HRA money can’t be used to reimburse an employee directly for costs associated with a health sharing plan.


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