Employee reimbursement amounts are based on approved claims, available allowance balances, and your HRA plan rules.
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
What if an employee's premium is greater than their allowance?
Employees are generally reimbursed up to their available allowance amount.
Example
Monthly premium: $708.00
Monthly allowance: $308.25
Out-of-pocket cost: $708.00 − $308.25 = $399.75
Eligible reimbursement: $200
The remaining balance is not reimbursed unless otherwise permitted by the plan.
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.
Example
Monthly premium: $381.28
Monthly allowance: $447.00
Leftover funds: $447.00 − $381.28 = $65.72
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.
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.
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.