Get the free Health Reimbursement Arrangement (HRA) Claim Form

Form used to request reimbursement for eligible medical expenses under a Health Reimbursement Arrangement.

How to fill out health reimbursement arrangement hra

How to fill out Health Reimbursement Arrangement (HRA) Claim Form

1. Obtain the Health Reimbursement Arrangement (HRA) Claim Form from your employer or benefits administrator.
2. Fill in your personal information at the top of the form, including your name, address, and contact details.
3. Enter your employee ID or Social Security number if required.
4. List the medical expenses for which you are seeking reimbursement, including dates, descriptions, and amounts.
5. Attach all necessary supporting documentation, such as receipts or invoices, to validate your claim.
6. Review the form for any errors or missing information before submitting.
7. Sign and date the form where indicated to certify the claims are correct.
8. Submit the completed claim form and documentation to the designated claims processor as specified by your employer.

Who needs Health Reimbursement Arrangement (HRA) Claim Form?

1. Employees covered by a Health Reimbursement Arrangement (HRA) who incur qualifying medical expenses.
2. Individuals seeking reimbursement for out-of-pocket healthcare costs.
3. Employers who offer HRAs to their employees to manage healthcare benefits.

People Also Ask about

What is the downside of HRA?

Under an HRA and HSA, the following premiums are reimbursable: long-term care insurance, Medicare Part A or B, Medicare HMO and employer-sponsored retiree health insurance premiums, and premiums for a health plan during a period in which an individual is receiving retirement compensation.

What are the negatives of HRA?

Variable Costs: Although HRAs can help control costs by setting fixed contribution amounts, the actual healthcare expenses might be unpredictable. This can make budgeting difficult, especially if employees' health care needs vary significantly.

How does an HRA affect my taxes?

HRA reimbursements are generally not taxable. The IRS generally does not tax reimbursements employees receive from an HRA. An exception is when employers reimburse non-medical expenses.

Is an HRA plan worth it?

An HRA offered in conjunction with a high deductible health plan (HDHP) can result in reduced healthcare costs. And you can typically use HRA funds to pay for deductibles, co-insurance, co-payments, and prescriptions, among other out-of-pocket healthcare expenses, depending on your plan details.

What is an HRA claim form?

HEALTH REIMBURSEMENT ARRANGEMENT (HRA) Supporting documentation for each expense must be provided with this Request form, describing the expenses and proving that the Participant, eligible Spouse, or eligible child paid the expenses.

Who benefits from an HRA?

HRAs reimburse employees for certain medical expenses and sometimes insurance premiums. Employers, not employees, fund HRAs. An HRA is not portable; employees lose this benefit when they leave the company. Government rules, which employers may refine further, determine which expenses can be reimbursed for employees.

How do I fill out a reimbursement form?

Risk of Underutilization: Employees might underutilize their HRA benefits if they find the process of paying upfront for care and waiting for reimbursement too cumbersome or if they are unaware of eligible expenses.

For pdfFiller’s FAQs

What is Health Reimbursement Arrangement (HRA) Claim Form?

The Health Reimbursement Arrangement (HRA) Claim Form is a document used by employees to request reimbursement for eligible medical expenses under an HRA plan.

Who is required to file Health Reimbursement Arrangement (HRA) Claim Form?

Employees who are enrolled in an HRA and have incurred eligible medical expenses are required to file the HRA Claim Form to receive reimbursements.

How to fill out Health Reimbursement Arrangement (HRA) Claim Form?

To fill out the HRA Claim Form, complete personal information, itemize the medical expenses being claimed, provide necessary documentation for the expenses, and submit it to the HR department or plan administrator.

What is the purpose of Health Reimbursement Arrangement (HRA) Claim Form?

The purpose of the HRA Claim Form is to enable employees to request reimbursement from their employer-provided health reimbursement arrangement for eligible healthcare costs.

What information must be reported on Health Reimbursement Arrangement (HRA) Claim Form?

The HRA Claim Form should report the employee's name, contact information, details of the medical expenses incurred, the dates of service, the amount being claimed, and any required receipts or documentation.