Short answer: A QSEHRA is limited to employers with fewer than 50 full-time-equivalent employees that do NOT offer a group health plan, and it must be offered to all full-time employees on the same terms.
A Qualified Small Employer HRA (QSEHRA) is designed for small employers: the business must have fewer than 50 full-time-equivalent employees and must not offer any group health plan. It has to be offered to all full-time employees on the same terms, and reimbursements are capped at annual IRS limits ($6,450 self-only / $13,100 family for 2026). Employees use it tax-free for individual-market premiums and qualified medical expenses, provided they have minimum essential coverage.