Plan Information & Enrollment
Plan Summary/Summary Plan Description
The Plan Summary/Summary Plan Description contains information to help you understand and use your HRA. It also contains the following important notices:
- Privacy Notice
- COBRA Notice
- USERRA Notice
- FMLA Notice
- Medicare Part D Notice of Non-Creditable Coverage
- Coordination of Benefits with Medicare
- Exemption from Annual Limit Restrictions
- Premium Tax Credit Eligibility
To get a current copy of the Plan Summary/Summary Plan Description, log in and click Resources.
Plan Benefits Brochure
Our Plan Benefits brochure is an excellent educational tool if you are a newly-enrolling participant or just need a refresher. It contains general plan information and contains answers to the most frequently asked questions.
The specific terms of your HRA depend on your employer’s plan design. Your HRA may be subject to vesting, post-separation benefits only, or other limitations. You should check with your employer to learn more about the specific terms of your plan.
Your spouse and qualified dependents, including your young-adult children through the calendar year in which they turn age 26, are eligible for coverage. Generally, dependents must satisfy the IRS definition of Qualifying Child or Qualifying Relative as of the end of the calendar year in which expenses were incurred to be eligible for benefits. These requirements are defined by Internal Revenue Code section 105(b). The IRS definitions supersede and may differ from state definitions.
To learn more read Definition of Dependent in the Plan Summary/Summary Plan Description.To get a current copy, log in and click Resources.
Qualified Expenses & Premiums
Qualified medical care expenses and premiums eligible for reimbursement depend upon your employer’s plan design or certain elections you may make to limit or permanently waive your HRA coverage (read Coordination of Benefits and Premium Tax Credit Eligibility below to learn more about when you may need to limit or permanently waive your HRA coverage). Some employer plan designs limit reimbursements to qualified insurance premiums or certain excepted benefits only.
Common qualified out-of-pocket expenses include deductibles, co-pays, coinsurance, prescription drugs, and certain over-the-counter (OTC) items. Eligible insurance premiums include:
- Medical (includes marketplace exchange premiums that are not, or will not be, subsidized by the Premium Tax Credit);
- Tax-qualified long-term care (subject to IRS limits; read Tax Qualified Long-term Care Insurance Premium Limits below);
- Medicare Part B;
- Medicare Part D; and
- Medicare supplement plans.
Section 213(d) of the Internal Revenue Code defines qualified expenses and premiums, in part, as “medical care” amounts paid for insurance or “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body…” Expenses solely for cosmetic reasons generally are not considered expenses for medical care (e.g. face-lifts, hair transplants, hair removal (electrolysis)). Expenses that are merely beneficial to your general health, such as vacations, are not medical care expenses.
Please note the following:
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.
If you or your spouse has a section 125 healthcare flexible spending account (FSA), you must exhaust the FSA benefits before submitting claims to your HRA.
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 Qualified Expenses and Premiums handout to learn more. To get a copy, log in and click Resources.
Coordination of Benefits
Read the information below to learn how your HRA coordinates with healthcare flexible spending accounts (FSAs) and health savings accounts (HSAs).
If you or your spouse has a section 125 healthcare FSA, you must exhaust the FSA benefits before submitting claims to your HRA.
You can have an HRA and an HSA, and you can use either your HRA, if claims-eligible, or HSA to reimburse your qualified expenses (no ordering rules). But, if you have a claims-eligible HRA and want to become eligible to make or receive contributions to an HSA, you must first elect limited HRA coverage. You can switch your HRA back to full coverage after you stop making or receiving HSA contributions (certain limitations may apply) or after you have met the required annual deductible for your HSA-eligible high-deductible health plan, whichever occurs first.
To elect limited HRA coverage, submit a Limited HRA Coverage Election form. To access forms, log in and click Resources.
Summary of Benefits and Coverage
As a participant in the HealthInvest HRA, the benefits available to you under the Plan, as well as any limitations, are important. To help you understand the types of benefits provided by the Plan and any applicable limitations, the Plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about your benefits. Please note that the format and content in the SBC is required by federal regulation and is designed to apply to health insurance plans. Your HRA is not a health insurance plan. Therefore, the SBC indicates that some of the information and defined terms are not applicable to your HRA. To get a copy of the SBC, log in and click Resources.