Claims

 

How to File a Claim

 

After enrolling and becoming claims-eligible, most participants can submit claims and supporting documentation (proof of expense) online after logging in or via our mobile app, HRAgo®. 

 

If you prefer, you can submit a paper Claim Form. Detailed instructions are contained on the form. The Claim Form is available from this site under Forms, after logging in or upon request from our customer care center.

 

You may request reimbursement of qualified medical care expenses and/or insurance premiums you have incurred on behalf of yourself, your legal spouse, and your qualified dependents. Qualified expenses and premiums submitted for reimbursement must have been incurred after you became a participant and eligible to file claims.

 

IRS rules require that you include proper proof of each expense. Missing, incomplete, or illegible forms of documentation are the most common reasons claims are denied. You can help avoid denied claims by making sure the proof you submit is legible and contains all of the following:

 

1. Name of patient or covered individual who received the item or service;

2. Date item was purchased or service was provided;

3. Service Provider name (e.g. doctor, pharmacy, hospital, etc.);

4. Description of the item purchased or service received; and

5. Amount of out-of-pocket expense.

 

Generally, all of the information we need is contained on any one of the following types of documents:

 

1. Explanation of benefits (EOB) from your insurance company (recommended);

2. Itemized statement of services from your doctor or other service provider;

3. Stub or “bag tag” from a prescription (not the cash register receipt); or

4. Detailed receipt for over-the-counter (OTC) medicines.

 

Please note the following:

 

1. IRS regulations provide that insurance premiums paid by an employer, deducted pre-tax through a section 125 cafeteria plan, or subsidized by the Premium Tax Credit are not eligible for reimbursement. If requesting reimbursement of premiums deducted from your paycheck after tax, you must include a letter from your employer that confirms no pre-tax option is available. Qualified insurance premiums deducted from your legal spouse’s paycheck after tax are eligible for reimbursement.

2. If you or your legal spouse has a section 125 healthcare flexible spending account (FSA), you must exhaust the FSA benefits before submitting claims to your HRA.

3. Claims for over-the-counter (OTC) medicines and drugs (except insulin and contact lens solution) must be prescribed by a medical professional or accompanied by a note from a medical practitioner recommending the item or service to treat a specific medical condition. Thus, OTC medicines and drugs such as aspirin, antihistamines, and cough syrup must be prescribed. The prescription requirement applies only to medicines and drugs, not to other types of OTC items such as bandages and crutches.

 

Read our How to File a Claim handout to learn more. To get a copy, log in and click Resources, or request a copy from our customer care center.

 

 

 

Automatic Premium Reimbursements

 

After enrolling and becoming claims-eligible, you can set up automatic reimbursement of ongoing qualified insurance premiums on behalf of yourself, legal spouse, and qualified dependents. Automatic premium reimbursements can be set up online (recommended) after logging in.

 

If you prefer, you can submit a paper Automatic Premium Reimbursement form. Instructions are contained on the form.  Forms are available after logging in or upon request from the customer care center.

 

You must provide supporting documentation that includes:

 

1. Name(s) of covered individuals or policy holder;

2. Premium amounts;

3. Policy period; and

4. Insurance provider name.

 

This information is typically contained on your premium billing notice, statement of insurance, open enrollment notice, pension benefit direct deposit stub, or similar form of documentation.

 

Please note the following:

 

1. IRS regulations provide that insurance premiums paid by an employer, deducted pre-tax through a section 125 cafeteria plan, or subsidized by the Premium Tax Credit are not eligible for reimbursement. If requesting reimbursement of premiums deducted from your paycheck after tax, you must include a letter from your employer that confirms no pre-tax option is available. Qualified insurance premiums deducted from your legal spouse’s paycheck after tax are eligible for reimbursement.

2. Claims-eligible participants who are actively-employed and receiving monthly employer contributions must have a minimum account balance of $2,000 to begin or renew an automatic premium reimbursement (or payment).