A claim is partially reimbursed when your eligible HRA allowance available at the time of processing is less than the total amount of your submitted expense, so only a portion of the claim can be paid and the remaining balance is carried forward for future reimbursement.
Why was my claim only partially reimbursed?
Your claim is partially reimbursed because your available HRA allowance has been used up for the current year-to-date (YTD) period at the time the claim is processed.
This happens when:
Your total submitted claims are greater than your available allowance
Your allowance is applied incrementally on a monthly basis
Part of your claim must wait for future allowance allocations
The unpaid portion of your claim is not denied—it remains eligible and will be reimbursed when additional allowance becomes available.
Let's break it down:
Your HRA allowance is an annual benefit which is unlocked on a monthly basis for you to submit reimbursement requests against.
When your total reimbursement claims YTD are more than your total available allowance YTD, it will leave a portion of your claims "unreimbursed."
Our system will apply each month’s new allowance to the oldest claim first.
The “Reimbursed” column represents how much of a claim has been reported on your employer’s monthly, semi-monthly or bi-weekly Reimbursement Statement that we provide them.
The sum of the "Reimbursed" column is equal to your allowance YTD, or at least as of the date of your employer's last Reimbursement Statement.
We will continue to track your unreimbursed claims over time and continue to apply each month's allowance to them until they are paid in full.
Here are a few examples of times when you may see this happen.
Example #1 - Your premium is larger than your monthly allowance
For this example, let's use the following:
Your HRA allowance is $400 per month
Your monthly insurance premium is $600 per month
You set up your recurring premium claim for $600 per month
In this case, our system will automatically create a $600 claim on your behalf each month. So in January, it's easy, right? You know January's $400 allowance is applied to your $600 claim for January.
But remember, each new allowance will be applied to the oldest claim first. That means that your February $400 allowance will first be applied to the remaining balance on the January premium claim until it's reimbursed in full.
This doesn't mean that in January, you received $600, and in February you received $200. It just means that YTD, you have been reimbursed or will be reimbursed $800 total, and the $800 was applied to your claims in order of their submission.
If you would like us to update your recurring claim to be equal to your monthly reimbursement so your claims list looks a little "cleaner," reach out to support@takecommandhealth.com or chat with us in the bottom right hand corner, and we'll get it updated!
Example #2 - You submit a large medical bill for reimbursement
Let's take a look at what happens in your account when you submit a medical bill that is larger than your monthly allowance.
For this example:
Your HRA allowance is $400 per month
Your HRA went into effect January 1st
In January, you go to the ER and have a $1,000 bill that you submit for reimbursement. As of January, you only have $400 available in reimbursement allowance. We will automatically apply your January $400 allowance to your claim, and we'll report to your employer that you are owed $400. But for the rest of the month, you'll see that it shows only $400 has been reimbursed.
Then in February, another $400 of HRA allowance will get unlocked. Even if you have submitted a new claim, your February allowance of $400 will get applied to the older claim first. So now January & February's $400 allowances are applied to the $1,000 hospital bill. In March the remaining balance of the ER visit will be reimbursed ($200) and the additional medical expense of $132.75 that was approved previously will now be reimbursed with the available funds.
How does my HRA allowance affect reimbursement?
Your HRA allowance is structured as an annual benefit that is made available monthly.
Each month:
A portion of your annual allowance becomes available
Eligible claims are applied against that monthly allowance
Any unused or overused balance is carried forward
If your claim exceeds the available amount, the system pays only what is currently available.
What happens to the unpaid portion of my claim?
The remaining unpaid balance is not lost.
Instead:
It is tracked in your account as an outstanding eligible balance
Future monthly allowances are automatically applied to it
Reimbursement continues until the full eligible amount is paid
This process continues until your total allowance is fully exhausted or the claim is fully reimbursed.
Why did my reimbursement change over time?
Reimbursements may appear to change month-to-month because:
New monthly allowance is added to your account
The system applies new funds to the oldest unpaid eligible claims first
Older claims may receive additional partial payments over time
This means reimbursement is processed cumulatively rather than all at once.
Does partial reimbursement mean my claim was denied?
No. Partial reimbursement does not mean denial.
It means:
The claim is valid and eligible
Only part of the claim could be paid based on available funds at that time
The remaining portion will be reimbursed later as funds become available
A denial would mean the expense is not eligible at all.
Do I need to resubmit a partially reimbursed claim?
No. You do not need to take any action.
The system will automatically:
Track remaining eligible balance
Apply future allowance amounts
Continue reimbursement until the claim is fully paid
Resubmitting the claim is not required and may cause duplication.
Why does my “reimbursed” amount differ from my claim total?
The “reimbursed” amount reflects:
What has been paid to date
Based on available allowance at each processing period
It may not reflect the final total if:
Your allowance is still being accumulated
The claim spans multiple months of reimbursement processing
The final total will equal your eligible allowance applied to the claim.