Employee reimbursement amounts are based on approved claims, available allowance balances, and your HRA plan rules.
For example, in 2025 and 2026, the maximum allowance is $1,091.67 per person.
What factors determine reimbursement amounts?
Reimbursement amounts may be based on:
Monthly allowance amounts
Approved premiums
Approved medical expenses
Available allowance balances
Plan design rules
Accumulated unused allowance balances- Reimbursements are limited to the lesser of the monthly allowance or the submitted eligible expenses.
What if an employee's premium is greater than their allowance?
Employees are generally reimbursed up to their available allowance amount. Excess amounts do not carry over unless the employer's plan explicitly supports cumulative catch-up.
Additionally, out-of-pocket differences are often deducted from paychecks.
Example
Monthly premium: $708.00
Monthly allowance: $308.25
Out-of-pocket cost: $708.00 − $308.25 = $399.75- Monthly premium: $771.11
Monthly allowance: $441.66
Out-of-pocket cost: $771.11 − $441.66 = $329.45
Eligible reimbursement: $200
The remaining balance is not reimbursed unless the employer's plan explicitly supports cumulative catch-up.
What if an employee's premium is less than their allowance?
Employees may receive reimbursement for the approved premium amount.
If allowed by the plan, employees may be able to use remaining allowance amounts for other eligible expenses. The system prioritizes premium reimbursement first, and leftover allowance (if any) can be used for eligible medical expenses.
If the premium is fully covered by the allowance, there will be no payroll deduction.
Example
Monthly premium: $381.28
Monthly allowance: $447.00
Leftover funds: $447.00 − $381.28 = $65.72- Monthly premium: $400
Monthly allowance: $650
Leftover funds: $650 − $400 = $250
Eligible reimbursement: $150
Additional eligible expenses may be reimbursable depending on the plan design. For instance, if $65.72 is left over each month for 10 months, the accumulated amount is $657.20. This can be used to reimburse a submitted medical expense.
Do unused allowances carry forward?
Allowance availability depends on your HRA type and plan rules.
Review your plan documents for rollover and carry-forward provisions. Employees can claim past balances if they are within the same plan year. Additionally, they may submit eligible out-of-pocket medical expenses to use any remaining allowance. Claims for past plan years must be submitted through the legacy platform, as the new HRA Hub only manages current and future plan years.
Unused allowances typically roll over month-to-month within the plan year, allowing employees to claim additional eligible expenses later.
Can reimbursement amounts change?
Yes. Reimbursement amounts may change if:
Coverage changes
Premium amounts change
Claims are adjusted
Eligibility changes
Additional documentation is submitted
Allowance changes: If the allowance decreases, any remaining balance of a submitted claim carries forward to future months. If the allowance increases, the additional amount is applied to the remaining balance of the claim until it is fully reimbursed. When a member’s premium changes mid-year, the recurring premium amount must be updated in the HRA member portal. The system will automatically adjust reimbursements up to the approved monthly maximum.- Unreimbursed amounts from when premiums exceeded the allowance may be carried forward and reimbursed when funds become available.- If premiums change mid-year, ensure the prior premium ends in the correct month and the new premium starts in the correct month. For example, if a premium decreases in May, the prior premium should end in April and the new premium should start in May.
Approved reimbursement amounts are reflected on future reimbursement statements. Reimbursement statements include details such as the current month’s allowance, any unused allowances carried over, and the total approved expenses submitted for reimbursement. If you upload a new reimbursement document, it will replace the old one for active use, while the prior document remains in the history for reference. Additionally, corrections processed will reflect updated reimbursement amounts in the Claims Summary for the affected months.
Employees must submit acceptable proof of coverage, including their name or dependent status, premium amount, current date (within the last 30 days), and plan name and provider.