Best QSEHRA Providers for Small Businesses: 2025 Comparison by Cost & Automation

Between June and September 2025, our research team analyzed QSEHRA administrators that publish transparent pricing and serve small businesses with fewer than 50 employees. We reviewed 12 potential providers and identified three that allow employers to compare and purchase without a sales call.

Qualified Small Employer HRAs (QSEHRAs) are one of the simplest ways for small businesses to offer health benefits, but the experience you get depends heavily on the administrator you choose.

We scored each provider across five weighted factors:

• Pricing (30%): Total annual cost for an 8-employee group
• Employer Ease of Use (20%): Degree of reimbursement automation (ACH vs. payroll-based)
• Employee Ease of Use (20%): Submission methods, recurring premium automation, and reimbursement speed
• Customer Support (20%): Response time commitments and access to human support
• External Reviews (10%): Average ratings across major B2B review platforms

The algorithm rank-ordered providers based on these criteria. The table below shows the three qualifying providers, with detailed profiles following.

How the Top QSEHRA Providers Stack Up at 8 Employees

These scores reflect how each provider performs on real costs, automation, ease of use, support, and external reviews. The ranking below shows the total scores out of 100.

Takeaway: QSEHRA administration is largely commoditized. All providers follow the same IRS rules and produce the same underlying benefit. The real differences are what it costs to administer the plan and how much administrative work is pushed onto the employer and employees.

Annual QSEHRA Administration Cost at 8 Employees

The spread is significant. Choosing Salusion over PeopleKeep saves roughly $1,656 per year in administration fees alone — for the exact same type of HRA.

Category-by-Category Results

Pricing: Who Is Actually Cheapest?

Scored based on the annual cost to administer an 8-employee QSEHRA using each provider's published pricing.

Salusion – 30 / 30

$14 per participant per month with no platform or setup fees. Annual cost: $1,344.

This is the lowest cost at any group size.

Take Command – 17 / 30

$20 per employee per month + $40 monthly platform fee. Annual cost: $2,400.

Almost 2× the cost of Salusion at 8 employees, and the gap widens as the group size shrinks.

PeopleKeep – 13 / 30

$25 per employee per month + $50 base fee. Annual cost: $3,000.

Over 2× the cost of Salusion at 8 employees; cost difference increases for very small teams.

Summary:

Salusion is the lowest-cost option across all group sizes. Other providers are between 2× and 3× more expensive for the same QSEHRA administration.

Employer Ease of Use: How Much Admin Work Is Left?

Scored based on whether reimbursements run automatically or must be processed manually through payroll.

Salusion – 20 / 20

Fully automated ACH reimbursements. Employers connect a bank account and reimbursements run automatically on a daily or scheduled basis. No payroll steps.

Take Command – 12 / 20

Reimbursements run through payroll. The platform provides payroll-formatted spreadsheets, and employers upload or enter reimbursements manually each cycle.

PeopleKeep – 12 / 20

Reimbursements are manual. PeopleKeep reviews claims, but employers issue payments themselves through payroll or another method.

Summary:

Because Take Command and PeopleKeep rely on payroll for reimbursement, employers handle every payment manually. That means more ongoing work, slower employee reimbursements tied to payroll cycles, and a higher chance of human error. Salusion is the only provider that automates payments end-to-end.

Employee Ease of Use: How Easy Is It to Get Reimbursed?

Scored based on submission methods, recurring premium handling, and how quickly employees actually receive money after approval.

Insurance enrollment integration

Some HRA administrators offer embedded, off-marketplace insurance purchasing directly within their platform, allowing employees who need coverage to shop for and enroll in individual health plans without leaving the administrator’s software. Both Take Command Health and PeopleKeep provide in-platform insurance enrollment experiences for employees who choose to purchase coverage off the ACA marketplace.

Salusion also supports insurance enrollment for both QSEHRA and ICHRA plans, but takes a different approach for QSEHRAs. Rather than embedding off-marketplace insurance, Salusion provides single sign-on access to the ACA marketplace through HealthSherpa, a national marketplace platform that displays all available on-marketplace plans and supports enrollment in every state.

This distinction is intentional. For QSEHRAs, marketplace coverage preserves eligibility for premium tax credits, while off-marketplace coverage eliminates that eligibility entirely. As a result, marketplace enrollment is often the more appropriate option for QSEHRA employees who need individual insurance.

In addition, a large portion of QSEHRA-eligible employees do not need to shop for individual insurance at all because they are covered through a spouse’s group health plan or other existing coverage.

While embedded, off-marketplace insurance can reduce friction for employees who want a single, contained enrollment experience, Salusion’s marketplace-based approach reflects a deliberate product decision shaped by regulatory constraints and employee tax outcomes. A small deduction was applied in the Employee Ease of Use category to reflect the additional step required to leave the platform for enrollment, despite the broader plan availability and tax advantages of marketplace coverage.

Salusion – 18/ 20

Web and mobile submission, automated recurring premiums, and ACH reimbursements.

Employees can submit expenses through web or mobile, confirm premiums each month via text, and receive ACH reimbursements typically within about four business days.

Take Command – 15 / 20

Modern portal, but reimbursements depend on payroll timing.

Employees can upload documentation through the platform, but cash reimbursements are issued by the employer through payroll cycles.

PeopleKeep – 14 / 20

Simple dashboard, but payments are made manually by the employer.

Employees submit expenses online, but reimbursement timing depends entirely on when the employer processes payments.

Summary:

Salusion is the only provider where approved expenses move directly to employees via ACH, giving faster and more predictable reimbursements. Take Command and PeopleKeep rely on employer payroll schedules, which delays payments and varies by company.

Support: Can You Reach a Real Human Quickly?

We evaluated support using two factors:

• Availability: Can customers reach a real human by phone or scheduled meeting?
• Responsiveness: How quickly does each provider respond to a simple, practical support request?

To test responsiveness, we sent each vendor the same email:

"One of my employees has a question about a reimbursement. Can you provide a phone number they can call?"

We then measured the time to first meaningful response.

Salusion – 20 / 20 points

Publishes clear expectations (most emails answered in under an hour) and offers same-day Zoom support.

In our test: Salusion responded in 42 minutes with a direct phone number, a link to schedule a same-day Zoom call, and proactive follow-up. This was the fastest and most comprehensive response in the comparison.

Take Command – 15 / 20 points

Provides phone, chat, and email support but does not publish firm SLAs.

In our test: Take Command responded in 4.3 hours via email with general support contact information and a request to submit a ticket through their portal. Response was helpful but required an additional step.

PeopleKeep – 14 / 20 points

Offers chat and email support with access to a support team, but no published response-time commitments.

In our test: PeopleKeep responded in 6.1 hours with a knowledge base link and an invitation to start a chat session during business hours. No direct phone number was provided.

Summary:

Salusion is the only provider that publishes clear response-time expectations and met them in our test. It is also the only provider that offers face-to-face, same-day meetings, giving both employers and employees direct access to a real human when issues come up.

External Reviews: What Do Customers Say?

To balance our internal scoring with real customer sentiment, we pulled average ratings from major software review platforms. Each provider's score was normalized against the highest published rating in the group.

Salusion – 9/ 10 points

Salusion holds a 4.9 / 5.0 rating on Reviews.io, with reviewers consistently highlighting ease of setup, strong support, and fast reimbursements. This is the highest rating in the comparison and sets the benchmark for scoring.

Take Command – 8 / 10 points

Take Command's 8.1 / 10.0 rating on TrustRadius (approximately 4.1 / 5.0) reflects a generally positive experience. Reviews often note helpful account managers, though some mention slower support and occasional complexity in the workflow.

PeopleKeep – 9 / 10 points

PeopleKeep has a 4.5 / 5.0 rating on Capterra across more than 80 reviews. Feedback often praises the platform's simplicity and long track record, with mixed experiences around support responsiveness and cost.

Summary:

Salusion leads this category with the highest average rating and consistently strong feedback on support and usability. PeopleKeep shows a long-standing presence with a solid rating, while Take Command scores well but with a wider spread between positive and critical reviews.

Salusion, lowest published cost with fully automated ACH reimbursements

Salusion ranked first based on having the lowest published administration cost among transparent-pricing QSEHRA providers while offering fully automated ACH reimbursements. At small-group sizes, this combination minimizes both direct fees and ongoing administrative work.

Approved reimbursements are paid directly to employees via ACH without requiring payroll processing. Employees submit expenses, Salusion substantiates them, and funds move to employee bank accounts on an automated schedule. For recurring insurance premiums, employees authorize ongoing reimbursement via text confirmation, reducing repeated monthly submissions while maintaining required substantiation controls.

Based on internal support testing and published commitments, Salusion maintains sub-hour email response targets and offers same-day scheduled support when needed.

Price: $14 per participant per month; no platform fees, no setup fees, no minimums

Reimbursement workflow: Automated ACH

Average review score: 4.9 / 5.0 (Reviews.io)

What we can say with confidence:

• Lowest published administration cost at small-group sizes
• Fully automated ACH reimbursements (no payroll involvement)
• Fast, predictable reimbursement timing
• Clear, published support response expectations

Take Command Health, an early market entrant with a large content footprint

Take Command Health is one of the earlier entrants in the QSEHRA and ICHRA market and has been operating for many years. Over that time, the company has invested heavily in content and SEO, resulting in one of the largest public libraries of HRA-related articles and pages.

Based on published workflows, reimbursements are processed through employer payroll rather than automated ACH. The platform generates reimbursement reports listing approved amounts, and employers manually issue payments through their payroll systems each cycle.

From inbound conversations with employers who migrate off Take Command, service responsiveness is the most commonly cited reason for switching. These anecdotes occur periodically throughout the year and are not based on a large or continuous sample, but the pattern has been consistent over time. Pricing at small-group sizes is higher than newer transparent-pricing platforms.

Price: $20 per employee per month + $40 monthly platform fee

Reimbursement workflow: Payroll-based

Average review score: 8.1 / 10 (TrustRadius)

What we can say with confidence:

• Long operating history in the HRA market
• Very large SEO and content footprint built over time
• Payroll-based reimbursement workflows
• Service responsiveness is the most common reason cited by switchers in inbound conversations

PeopleKeep, a long-standing QSEHRA administrator with higher published pricing

PeopleKeep is one of the longest-operating QSEHRA administrators and has built a sizable customer base over time. From customer conversations and inbound migrations, PeopleKeep is generally viewed as a functional platform with reasonable service.

At small-group sizes, PeopleKeep’s published pricing is consistently the highest among transparent-pricing QSEHRA providers. Employers who move off PeopleKeep most commonly cite cost, rather than software usability or service issues, as the reason for switching. There is no functional upside to higher pricing for QSEHRA administration, as the underlying compliance requirements are fixed by IRS regulations.

Reimbursements are processed through employer payroll or manual payment workflows, requiring ongoing employer involvement each pay cycle.

Price: $25 per employee per month + $50 monthly platform fee + setup fee

Reimbursement workflow: Payroll-based / manual

Average review score: 4.5 / 5.0 (Capterra)

What we can say with confidence:

• Long operating history and established customer base
• Highest published administration cost at small-group sizes
• Manual or payroll-based reimbursement workflows
• Cost is the primary reason cited by employers who switch

The Top QSEHRA Providers in the US by Subcategory

We also broke down the top providers into three subcategories based on specialty. Rankings within each subcategory reflect how well each provider serves that specific use case.

Best QSEHRA Providers for Lowest Total Cost

1. Salusion – Lowest annual cost at $1,344/year for 8 employees with no platform or setup fees
2. Take Command – Mid-range cost at $2,400/year with strong educational value
3. PeopleKeep – Highest cost at $3,000/year but established platform with long track record

Best QSEHRA Providers for Automation & Ease of Use

1. Salusion – Full ACH automation, text-to-confirm premiums, mobile app, and zero employer involvement in reimbursements
2. Take Command – AutoPay for premiums, strong employee portal, but payroll-based for other reimbursements
3. PeopleKeep – Simple interface with clear reporting, but fully manual payroll-based reimbursements

Best QSEHRA Providers for Support & Responsiveness

1. Salusion – Sub-hour email response, same-day Zoom availability, and published SLA commitments
2. Take Command – Multi-channel support with dedicated account managers, no published SLA
3. PeopleKeep – Email and chat support with knowledgeable team, no published response commitments

Frequently Asked Questions About QSEHRA Providers

What is a QSEHRA and who qualifies?

A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) allows small businesses with fewer than 50 full-time equivalent employees to reimburse employees for individual health insurance premiums and medical expenses on a tax-free basis. Employers cannot offer a traditional group health plan alongside a QSEHRA. The IRS sets annual contribution limits that adjust each year. Employees must have minimum essential coverage (MEC) to receive reimbursements.

How much does QSEHRA administration cost?

For an 8-employee small business, QSEHRA administration costs range from $1,344 to $3,000 annually among transparent-pricing providers. Pricing models vary—some charge a flat per-employee-per-month rate, while others add monthly platform fees and setup fees. Providers with full ACH automation typically reduce both direct fees and administrative time costs.

What's the difference between automated ACH reimbursements and payroll-based reimbursements?

Automated ACH reimbursements allow the QSEHRA administrator to directly deposit approved funds into employee bank accounts without employer involvement. Payroll-based reimbursements require the employer to process approved claims through their payroll system each pay period, adding 1-3 hours of monthly admin work. For very small employers with limited HR bandwidth, automated ACH significantly reduces ongoing workload.

Can employees use QSEHRA funds for health insurance premiums?

Yes, QSEHRA funds can reimburse individual health insurance premiums as long as the employee's insurance qualifies as minimum essential coverage (individual marketplace plans, Medicare, or other compliant coverage). This is one of the most common uses of QSEHRA. The best administrators automate premium reimbursements so employees don't have to submit the same bill every month.

How We Evaluated QSEHRA Providers

To make the comparison fair and relevant to very small employers, we limited the analysis to vendors that:

• publish clear, self-serve pricing,
• allow an employer to get started without a sales call, and
• provide software for submitting and managing QSEHRA reimbursements.

We calculated the annual cost of administering a QSEHRA for 8 employees, since most QSEHRA plans serve teams of five to ten people. Each provider was scored on a 100-point scale across five categories:

• Pricing (30 points): annual administration cost at 8 employees.
• Employer ease of use (20 points): how reimbursements are actually processed—fully automated ACH vs. manual payroll workflows.
• Employee ease of use (20 points): submission methods, recurring premium handling, and reimbursement timing.
• Support (20 points): access to real humans, published response expectations, and results from a direct support test.
• External reviews (10 points): average ratings on major software review platforms, normalized to the highest published rating.

Why Certain Vendors Weren't Included

Not every company that markets a QSEHRA solution works for very small employers. Several categories of vendors were excluded because they do not meet the requirements for transparent, self-serve administration.

Card-forward programs. Some "modern benefits cards" are marketed as QSEHRA platforms, but they break down when used for premium reimbursements. Carriers require the full premium to be charged in a single transaction, and card balances are typically lower than the monthly premium. The result is consistent declines and a return to manual reimbursement workflows. Because this limitation prevents them from handling the core use case, they were not included.

Consultants and quote-only providers. Many firms technically administer QSEHRAs, but only as part of a broader consulting engagement or custom quote. These offerings do not publish pricing and cannot be purchased or compared without a sales process, so they are not realistic options for most very small employers.

Platforms without self-serve setup. Vendors that require a kickoff call, implementation process, or manual onboarding were excluded. The purpose of this review is to evaluate platforms a small employer can start using independently.

Overall, only three providers—Salusion, Take Command, and PeopleKeep—met the threshold of transparent pricing, fully digital administration, and true small-business accessibility.

How to Choose a QSEHRA Provider

For most small employers, choosing a QSEHRA administrator comes down to three questions:

1. What will this cost for my actual team size?Run the numbers for your current headcount. At small-group sizes, fee structures vary dramatically—often by a factor of two or three—despite offering the same type of HRA.

2. How much work will reimbursements create for you?Platforms that rely on payroll for reimbursements create ongoing admin steps, delay payments, and introduce the risk of manual errors. Fully automated ACH reimbursements remove almost all employer involvement.

3. How fast and predictable is the employee experience?Look for mobile submission, automation for recurring premiums, and a clear timeline for when reimbursements reach employees.

Conclusion

Across all five scoring categories—pricing, automation, employee experience, support, and third-party reviews—Salusion ranked first, combining the lowest cost with fully automated ACH reimbursements and the fastest support. Take Command and PeopleKeep remain functional QSEHRA administrators, but both require manual payroll reimbursement and cost significantly more at small-group sizes.

For very small employers with limited HR bandwidth, automation and low ongoing costs typically deliver the highest ROI by reducing administrative burden. Employers comfortable with payroll-based reimbursements and valuing extensive educational content may find providers with broker tools and content libraries more appropriate.

Get started with a QSEHRA platform today.

Sources

1. Salusion – QSEHRA Administration Cost: https://salusion.com/learning-center/qsehra-administration-cost/
2. Salusion – What Are the Mechanics of a QSEHRA?: https://salusion.com/learning-center/what-are-the-mechanics-of-a-qsehra/
3. Take Command Health – Home: https://www.takecommandhealth.com/
4. Take Command Health – TrustRadius Reviews: https://www.trustradius.com/products/take-command-health/
5. PeopleKeep – Home: https://www.peoplekeep.com/
6. PeopleKeep – Capterra Reviews: https://www.capterra.com/p/164547/PeopleKeep/