If your employee has a claim that is only partially reimbursed, in short, it means that they have used up their allowance year-to-date. 

Let's break it down:

  • The HRA allowance is an annual benefit which is unlocked on a monthly basis and prorated for the number of months your employee has been eligible.

  • When the total reimbursement claims YTD are more than the total available allowance YTD, it will leave a portion of the 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 to you on your Reimbursement Statement. We assume you reimburse your employees after you have your statement run each month.

  • The sum of the "Reimbursed" column is equal to your employee's prorated allowance YTD, or at least as of the date of your last Reimbursement Statement.

  • We will continue to track your employee's 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 - Employee's premium is larger than the monthly allowance

For this example, let's use the following:

  • You offer an HRA allowance or $400 per month

  • Your employee's monthly insurance premium is $600 per month

  • Employee sets up their recurring premium claim for $600 per month

In this case, our system will automatically create a $600 claim on  your employee's behalf each month. So in January, it's easy, right? You know January's $400 allowance is applied to the $600 claim for January.

But remember, each new allowance will be applied to the oldest claim first. That means that the 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 reimburse them $600, and in February you reimburse them $200. It just means that year-to-date as of February, you have reimbursed your employee will reimburse $800 total, and the $800 was applied to your employee's claims in order of their submission.

Example #2 - Your employee submits a large medical bill for reimbursement

Let's take a look at what happens an employee submits a medical bill that is larger than the monthly HRA allowance. 

For this example:

  • You are offering an allowance or $400 per month

  • Your HRA went into effect January 1st

In January, your employee goes to the ER and has a $1,000 bill that they submit for reimbursement. As of January, he or she only has $400 available in reimbursement allowance. We will automatically apply the January $400 allowance to this claim, and your January Reimbursement Statement will show that your employee is owed $400. But for the rest of the month after your Reimbursement Statement runs, you'll see that it shows only $400 has been reimbursed.

Then in February, another $400 of HRA allowance will get unlocked. Even if your employee has submitted a new claim, the 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 marked as reimbursed ($200) and the additional medical expense of $132.75 that was approved previously will now be reimbursed with the available funds. 

Still not sure where to start? Check out our Admin Resource Center for more resources and support.

Can I submit a medical expense claim larger than my QSEHRA monthly allowance?

What if I do not claim my maximum reimbursement allowance each month?

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