Claims

How to File a Claim

After enrolling and becoming claims-eligible, most participants 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 page 1 of the form. The Claim Form is available from this site under Forms, after logging in, or upon request from our customer care center.

 

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 legal spouse, and your eligible 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 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. 

 

Cancelled checks, carbon copy checks, credit or debit card receipts, bank statements, and balance forward or payment on account statements do not contain all of the required information and are not acceptable. Common forms of acceptable documentation include:

  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 and prescription 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.

  2. If you or your legal spouse has a section 125 health 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 via e-mail, regular mail, or fax as indicated on the form. Instructions are contained on the form. Forms are available after logging in or upon request from our customer care center.

 

You must provide documentation that includes:

 

  1. Name of covered individual(s);

  2. Coverage period or effective date;

  3. Name of insurance carrier; and

  4. Premium amount.

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.

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

 
 
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