PeopleKeep is a benefits administration company. It does not sell health coverage and it does not carry risk. It sells software that lets you run an HRA, which means you reimburse employees for insurance they bought themselves, and it charges a fee for every enrolled employee to do it. That is a legitimate model and a useful one for some companies. It is also, for many of the companies that buy it, a subscription fee on top of a health plan that nobody helped them choose.
The short version
- Worth it?
- No: Prescience Choice, $20 per enrolled employee
- What it is
- HRA administration software, not a health plan
- Minimum seats
- Three
- Prescience Diamond
- An actual group plan with a managed network
What PeopleKeep customers report
PeopleKeep has a 2.0 TrustScore on Trustpilot, and 66% of its 35 reviews give one star. An HRA administrator has one core job, paying reimbursements on time, and that is what the reviews say goes wrong.
- Reimbursements reviewed slowly. A January 2026 employer wrote that PeopleKeep doesn't "provide timely reviews of insurance reimbursements which is the whole reason you would want a QSEHRA provider," and that staffing seems thin since its acquisition.
- Claims denied despite receipts. A May 2026 reviewer wrote that claims were rejected despite receipts and proof of payment, and a February 2025 reviewer wrote that PeopleKeep "asks for more and more documentation."
- Charged after cancelling. A November 2026 employer's card was charged for November after cancelling in October. In February 2026 another wrote that PeopleKeep "continued to charge us but suddenly locked us out and deactivated our account."
- Two weeks for an email. A February 2026 reviewer wrote, "My last email took 14 DAYS and 3 prompts to get a response!"
- Prices recalculated. A 2023 reviewer saw prices triple for a second company, then an unauthorized second charge the next day.
Trustpilot shows PeopleKeep replying to half of its negative reviews. Read the one- and two-star reviews on Trustpilot yourself, and ask any HRA administrator how long a reimbursement review takes in January.
A reimbursement account is not a health plan
This distinction gets lost in every HRA sales call, so let me draw it clearly. A health plan is coverage. You pay an insurer, the insurer holds the risk, and it pays claims. An HRA is an account. You promise to reimburse your employees for health spending out of your own money, and PeopleKeep provides the software that tracks the receipts and the limits.
Now the part HRA marketing skips past, and the part I got wrong myself for a while. When an employee on an ICHRA has a $90,000 claim, the insurer on their individual policy pays it, and you reimburse the premium up to your allowance. Your exposure is the allowance, and it stops there. A GCHRA works the same way against the cap you set, reimbursing out-of-pocket costs rather than premiums. Either way the allowance is your ceiling, not an uncapped claims bill. What HRA marketing does skip is the rest: you are not buying insurance, you are buying a filing cabinet with rules, and the policy it sits on is one an employee chose alone.
- QSEHRA: a small-employer reimbursement arrangement with an annual limit set by the IRS, available to employers under 50 full-time equivalent employees.
- ICHRA: an individual coverage arrangement for any size of employer, with no annual cap, where employees buy individual plans and you reimburse within a defined allowance.
- GCHRA: an arrangement paired with a group plan, typically reimbursing deductibles, copays and other out-of-pocket costs.
The base fee adds to the per-employee price
PeopleKeep publishes prices, which is to its credit and more than most of the PEO market manages. The numbers, as listed on its own site in October 2026, are $25 per employee per month plus a $50 base fee for QSEHRA, ICHRA starting at $25 per employee per month plus a $50 base fee, and GCHRA at $12 per employee per month plus a $30 base fee. There is a three-seat minimum.
PeopleKeep lists a $50 monthly base fee for QSEHRA and ICHRA and $30 for GCHRA next to the per-employee price. On a small team, that base fee is a large share of the bill: on a five-person ICHRA it adds $10 a seat.
| Product | Per employee per month | Additional cost |
|---|---|---|
| QSEHRA | $25 | $50 monthly base fee |
| ICHRA | From $25 | $50 monthly base fee |
| GCHRA | $12 | $30 monthly base fee |
| Minimum seats | Three | Applies to the seat count, not the base |
| Health coverage itself | Not included | Employees buy their own |
The employee does the hard part
Here is the part that never makes it into the brochure. In an ICHRA, your employee goes to the individual market, picks a plan, pays the premium with their own money, submits proof, and waits to be reimbursed. The reimbursement is tax-free, which is the whole point. The shopping is mostly theirs too. PeopleKeep offers chat, email, scheduled calls and a session with a licensed advisor at enrollment, but it is self-service software, not a full-service broker.
For a twenty-eight-year-old engineer that is a mild inconvenience. For a parent with two children and a pediatric specialist, it is a project. For anyone whose first language is not English, or who has never bought insurance before, it is a place where a bad decision gets made quietly and shows up eighteen months later as a claim that is not covered.
The individual market also has narrower networks than most group plans. If your team is spread across several states, the plan options differ in each one, and the quality of what an employee can buy in one state is not the same as in another. A group plan gives everyone the same network. An HRA gives everyone a budget.
- Ask what shopping support exists, not what software exists. Who answers when an employee asks which plan covers their doctor?
- Ask about the reimbursement timeline. Employees fronting several hundred dollars a month before being repaid is a cash-flow problem for people who do not have cash flow.
- Ask what happens to someone who forgets to submit. An unused allowance is your money back, and a covered employee who missed out.
Where a pure HRA model breaks
I do not want to be unfair to this model, because it solves a real problem. A company with eight employees in six states cannot easily run a traditional group plan at a competitive rate, and an HRA gives those eight people a tax-free budget to buy coverage where they live. That is a better outcome than nothing, and better than a bad group plan priced for a population the carrier does not want.
The model breaks in three places. First, when your team is large enough to be attractive to a carrier, because a group plan will usually be cheaper and broader than eighteen people buying retail. Second, when your team is older or has dependents, because individual-market pricing for a family is not gentle. Third, when you want to recruit, because a reimbursement allowance is a weaker offer than a real plan with a network and a card.
The third one is unquantifiable and it is the one founders underestimate. Candidates compare offer letters. A health plan with a name and a network reads as a benefit. A budget you can spend on the individual market reads as a policy, and the recruiter has to explain it.
The honest comparison
Since the HRA model is close to what we do on Choice, I will be careful here. There are two questions worth asking, in order. First: do you want a group plan or individual coverage? Second: who administers the reimbursement, and at what price?
If the answer to the first is a group plan, an HRA-only vendor is the wrong answer whatever the price. You need a plan, not an account. If the answer is individual coverage, then compare administration and support, not just the per-employee fee, because the fee is the smaller number in the equation. Help with choosing a plan is the product. Software is the tool.
| Question | Group plan | HRA reimbursement |
|---|---|---|
| Who carries the risk | An insurer | You, within your allowance |
| Network | One managed network for everyone | Whatever each employee buys |
| Employee effort | Enrollment form | Shopping, paying, submitting, waiting |
| Cost predictability | A rate table | A budget plus your claims |
| Recruiting message | A plan with a name | A monthly allowance |
Notice that price is not in that table. That is deliberate. The reason to choose a group plan is not that it is cheaper on every census. It is that the risk, the network and the shopping sit with someone else, and for a team with families that is worth more than the difference in premium.
What to ask a PeopleKeep sales call
- What is the total monthly cost including the base fee, and what does that annualize to?
- Is the reimbursement tax-free for employees, and what are the eligibility rules?
- What shopping support do employees get, and who do they call when a plan question comes up?
- What is the reimbursement turnaround, and do employees pay upfront?
- Does the arrangement work in every state where we have staff?
- What happens if someone spends more than their allowance?
- Can we switch to a group plan later, and what does that transition cost?
Who PeopleKeep fits, and who should buy a group plan
| Your company | Does PeopleKeep make sense? |
|---|---|
| Eight people spread across six states | Yes. A group plan here is often poor value |
| A small team of healthy young people | Sometimes, if they are willing to shop |
| A team with families and children | Think hard. Individual-market family pricing is brutal |
| 30+ people in one or two states | Usually no. A group plan will be better |
| A company competing hard for hires | No. A budget is a weaker offer than a plan |
If what you want is a real group plan, with a network, a card and somebody else answering the plan questions, that is Diamond. If individual coverage genuinely fits your team, an ICHRA is the right structure and the question is who administers it well.
Price an ICHRA for your team
Compare a monthly allowance and administration costs with Prescience Choice. Each employee chooses an individual plan.
