Health Reimbursement Arrangement( HRA)
The HRA Plan has been established to help you pay for the out-of-pocket costs that are associated with the UFA group health insurance deductible.
1. Individual Deductible is $ 1,000 » Individual is responsiblefor the first $ 1,000 of their deductible. Anythingspent over $ 1,000 willbe automaticallyreimbursed to the employee.
2. Family Deductible is $ 2,000 » Family deductible can be satisfied by two( 2) individual deductibles being met or by multiple family members contributing to and satisfyingthe $ 2,000 deductible
* Note you will have to submit a manual claim for reimbursement for all out-of-network claims.
How do I get reimbursed? The HRA Plan will be administered by a third party provider APA Benefits, Inc. APA Benefits will work directly with SelectHealth when it comes to getting you reimbursed. You will no longer need to submit a claim form and an EOB form for reimbursement unless you go out of network to have services rendered. Your claim will be automatically paid via check or direct deposit after SelectHealth has entered the claim and sent the claim details to APA Benefits, Inc. APA Benefits will process these claims and payments weekly.
If you go out-of-network please follow these steps to be reimbursed:
1. Submit a copy of the most recent EOB( explanation of benefits) and a HRA claim form to APA Benefits, Inc.( This can be done online). We can’ t process your claim without the EOB.
2. You should receive your reimbursement via check or direct deposit within 1-2 business days after adjudication of the claim.
What can I be reimbursed for? 3. Individual deductibles over $ 1,000 or family deductibles over $ 2,000
4. You shouldn’ t use your FLEX card if you are going to be reimbursed by the HRA
5. You will not be reimbursed for copayments such as primary care, specialist, emergency room( ER) or prescription. Only services that are included in the deductible can be reimbursed through the HRA program.
Scenario John Doe visits an urgent care clinic after experiencing severe flu symptoms. When he receives his EOB from Select Health, it states that he has $ 1300 in services that are included in his deductible. APA Benefits, Inc. will automatically issue a reimbursement of $ 300 to him via either a check or ACH transfer.( If the services were provided by an out-of-network provider, he will need to submit the HRA claim form and EOB to APA Benefits, Inc. Once submitted, APA will process the claim and send him a check or ACH for $ 300).
After receiving the bill from the urgent care clinic, John Doe can pay the first $ 1,000 of his deductible using his Flexible Spending Account( FSA) funds( If John Doe didn’ t enroll int he FSA, he must pay the charges out of pocket).
John Doe is still eligible to receive up to an additional $ 700 in reimbursement this plan year if he incurs more expenses that are applied toward his deductible. This company’ s individual deductible is $ 2,000, and any expenses exceeding that amount will be reimbursed to the employee. The family deductible is $ 4,000.
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