How to File a Claim

After enrolling and becoming claims-eligible, you 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 via e-mail, regular mail, or fax as indicated on the form (faxing is sometimes unreliable and is not recommended). Detailed instructions are contained on the front side of the form. The Claim Form is available from this site under Forms. You can also find it after logging in and clicking Resources.

Standard claims processing time is five to seven business days from the day we receive your claim. If you are not enrolled in direct deposit, remember to allow adequate time to receive your paper check reimbursements in the mail. You can usually get your money back faster if you submit your claims online or via HRAgo.

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

You should save your receipts and related supporting documentation. The IRS requires us to verify every amount paid or reimbursed from your HRA. 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 covered individual;
  2. Date item was purchased or service was provided;
  3. Service Provider name (doctor, pharmacy, hospital, etc.);
  4. Description of the item purchased or service received; and
  5. Amount of out-of-pocket expense.

 All of the information we need is usually 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.

Read our How to File a Claim handout or the Plan Summary/Summary Plan Description to learn more. To get copies, log in and click Resources.



Automatic Premium Reimbursements

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

If you prefer, you can submit a paper Automatic Premium Reimbursement form via e-mail, regular mail, or fax as indicated on the form. Instructions are contained on the form. To access forms, log in and click Resources.

 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.