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Comparing Employee Health Benefits: Offering Insurance vs. Providing a Stipend

Deciding whether to offer health insurance as a benefit or provide a health insurance stipend involves considering various factors, including financial implications for both the employer and employees, administrative responsibilities, and the overall attractiveness of the benefits package. Here's a comparison of both options:

Offering Health Insurance as a Benefit


  1. Group Rates: Employers can often obtain better rates than individual plans, making it more cost-effective for employees.

  2. Pre-Tax Benefits: Premiums paid by employees can be pre-tax, reducing their taxable income.

  3. Employer Control: Ensures that employees receive a minimum level of coverage and benefits.

  4. Attractiveness to Employees: Can be a strong recruitment and retention tool, as employees often value health insurance highly.


  1. Cost: Depending on the size of the company and the type of plan, health insurance can be expensive for employers.

  2. Administration: Requires management of the plan, including dealing with renewals, claims issues, and employee inquiries.

  3. Inflexibility for Employees: Employees have less choice regarding their insurance provider and plan options.

Offering a Health Insurance Stipend


  1. Flexibility for Employees: Employees can choose the plan that best suits their needs, including the choice of providers and level of coverage.

  2. Simplicity in Administration: Reduces the administrative burden on the employer since the employer is not managing a group plan.

  3. Cost Control: Employers can fix the amount they contribute towards health insurance, helping to control costs.


  1. Tax Implications: Without proper structuring, stipends might be taxable income for employees, reducing the benefit.

  2. Less Bargaining Power: Employees purchasing insurance individually typically pay higher rates than those obtained through group plans.

  3. Reduced Benefit Visibility: May not be as attractive to potential hires as offering a traditional health insurance benefit.

Tax Considerations

For employers offering a stipend without sponsoring a specific plan, setting up a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) or an Individual Coverage Health Reimbursement Arrangement (ICHRA) can allow employees to use pre-tax dollars to purchase individual health insurance. These arrangements have specific requirements and limits but can offer tax advantages similar to those of traditional employer-sponsored plans.


The best option depends on the specific needs and circumstances of the business and its employees. Smaller companies might prefer the simplicity and cost control of a stipend, especially if they can structure it to provide tax benefits. Larger companies might lean towards offering traditional health insurance to leverage better rates and attract talent. Businesses should consult with a benefits consultant or tax professional to explore the most advantageous and compliant way to structure their employee health benefits.

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