HRA Explained: What You Need to Know [Definitive Guide]

Master Health Reimbursement Arrangements (HRAs) with our definitive guide covering types, benefits, compliance, and more. Tailor health benefits effectively.
health reimbursement account benefits

Are you navigating the complex world of healthcare benefits for your team? Understanding the various options can be daunting, but there’s one flexible solution that might just be what you need: the Health Reimbursement Arrangement, or HRA. Whether you’re an employer looking to provide versatile health benefits without the high costs, or an employee seeking clarity on how your healthcare expenses can be managed, HRAs offer a promising path.

Now, what is an HRA? A Health Reimbursement Arrangement (HRA) is an employer-funded plan that reimburses employees for qualified medical expenses and, in some cases, insurance premiums. HRAs are an integral part of the modern healthcare landscape, providing flexibility and control over healthcare costs to both employers and employees.

This guide is for employers considering offering HRAs, employees who want to understand the benefits available to them, and professionals in the healthcare and insurance sectors.

Understanding HRAs

HRAs were introduced by the Internal Revenue Service (IRS) as a way for employers to provide tax-advantaged health benefits. Over the years, regulations and provisions surrounding HRAs have evolved to include more flexibility and options for employers, such as the introduction of Individual Coverage HRAs (ICHRAs) and Excepted Benefit HRAs (EBHRAs).

How HRAs Work

HRA is a notional arrangement – no funds are expensed until reimbursements are paid. Employers decide how much money to contribute to the HRA each year. Employees then pay for health-related expenses out of pocket, which are later reimbursed by the employer, tax-free, up to a fixed amount.

Unlike Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), which are employee-owned accounts, HRAs are wholly owned by the employer. This means unused funds typically stay with the employer if an employee leaves the company. HRAs offer various benefits, including tax advantages for both employers and employees, and can be used to cover a wide range of health care expenses, from premiums to co-pays and even some over-the-counter medications.

employer funds

Types of HRAs

Health Reimbursement Arrangements (HRAs) are not a one-size-fits-all solution. Depending on the size of your business and the specific healthcare needs of your employees, different types of HRAs can be utilized to offer tailored benefits.

Integrated HRAs

Integrated HRAs are commonly paired with high-deductible health plans (HDHPs) and are designed for companies that offer a traditional group health plan. They cover a wide range of medical expenses that are not covered by the primary insurance. This setup is particularly beneficial in helping employees manage the higher out-of-pocket costs associated with HDHPs.

Qualified Small Employer HRAs (QSEHRAs)

For small businesses with fewer than 50 full-time employees that do not provide group health insurance, QSEHRAs offer a viable solution. These arrangements enable small employers to reimburse premiums for individual health insurance plans and other eligible medical expenses on a tax-free basis, making health coverage more accessible and affordable for small business employees.

Individual Coverage HRA (ICHRAs)

ICHRAs are suitable for employers of any size and offer considerable flexibility. They can reimburse premiums for individual health insurance plans and other medical costs. Unlike other HRAs, ICHRAs can be offered alongside any type of health insurance plan without restrictions on company size, providing an adaptable option for businesses that want to customize their benefits offerings.

Excepted Benefit HRA (EBHRA)

Excepted Benefit HRAs are designed to cover additional medical costs that aren’t covered by primary health insurance plans, such as dental and vision expenses. EBHRAs can be offered regardless of whether the employee takes the company’s health insurance, making them a flexible supplemental benefit. They are particularly useful in scenarios where employees need coverage for specific types of care that are not included in the primary plan.

Setting Up an HRA

To set up an HRA, it’s essential to understand both employer and employee eligibility criteria along with the legal and regulatory requirements. Employers must ensure that their HRA complies with IRS guidelines and the Affordable Care Act provisions. Employees, on the other hand, need to meet certain criteria set by the employer based on the type of HRA.

Creating an effective HRA plan involves several steps, starting from defining the budget to determining what expenses will be covered. Employers should consider their employees’ healthcare needs and tailor the HRA accordingly. For instance, a workforce with young families might benefit from an HRA that provides enhanced coverage for pediatric care and vaccinations.

Choosing the right HRA administrator is also crucial as they will help ensure that your plan complies with all regulatory requirements and handles claims efficiently. Employers must also establish a robust record-keeping system to manage reimbursements and maintain compliance with tax laws.

Funding and Contributions

Explore how Health Reimbursement Arrangements (HRAs) are funded and the dynamics of employer contributions and employee reimbursements.

Employer Contributions

Determining the right amount to contribute to an HRA is a strategic decision that impacts both the employer and the employee. Employers must consider their budgetary constraints and the healthcare needs of their workforce. A well-balanced contribution can enhance employee satisfaction and retention while providing tax benefits. Contributions made by employers to an HRA are tax-deductible, reducing the overall taxable income of the business, which can be a significant financial advantage.

Employee Reimbursements

HRAs are designed to reimburse employees for eligible healthcare expenses, which can include everything from doctor’s visits and prescriptions. The submission and approval process for reimbursements should be straightforward, typically requiring employees to provide proof of their medical expenses, such as receipts or invoices, which are then reviewed and approved by the employer or HRA administrator. This process must be clear and efficient to ensure employee satisfaction and trust in the benefits program.

eligible health care expenses

HRA Benefits and Coverage

Health Reimbursement Accounts primarily cover qualified medical expenses as defined by the Internal Revenue Service (IRS), but they can be customized to include a broader range of expenses depending on the employer’s policy. Typical expenses covered include co-payments, deductibles, prescriptions, and sometimes premiums for health insurance. However, non-medical expenses are generally not eligible under standard HRAs unless specifically outlined in an excepted benefits HRA, which can cover specific non-medical benefits such as dental and vision care.

Additionally, HRAs can be strategically combined with other insurance plans to maximize healthcare coverage and minimize out-of-pocket costs for employees. When HRAs are integrated with a group health insurance plan, they can help cover expenses that the primary insurance does not, effectively filling gaps in coverage.

Coordination of benefits is key in these setups to ensure that claims are processed correctly and that both the HRA and the health insurance plan are utilized effectively. This coordination helps streamline the benefits process, making it easier for employees to manage their healthcare expenses and for employers to maintain cost-effective coverage solutions.

Compliance and Regulations

As mentioned, Health Reimbursement Arrangements (HRAs) are governed by a variety of legal requirements, primarily outlined by the Internal Revenue Service (IRS) and the Affordable Care Act (ACA). Employers offering HRAs must ensure their plans comply with these regulations to maintain tax advantages and avoid penalties. Key responsibilities include maintaining privacy under HIPAA regulations, adhering to non-discrimination rules to ensure fairness, and ensuring that the HRA is properly integrated with a qualifying group health plan when necessary.

For HRAs, maintaining thorough documentation and meeting reporting requirements are critical. Employers must keep detailed records of all reimbursements to substantiate the tax-free status of their payments. Additionally, employers are required to report certain information about their HRAs to the IRS, such as contributions and reimbursements. The deadlines for these reports are typically aligned with other tax reporting obligations, making it essential for employers to stay vigilant and organized to meet all regulatory requirements.

Pros and Cons of HRAs

While HRAs offer significant benefits, understanding their full scope, including both advantages and potential drawbacks, is important for employers and employees alike.

Advantages of HRAs

HRAs offer significant tax benefits, as contributions made by employers are not subject to payroll taxes, and reimbursements received by employees are generally tax-free. This setup can lead to substantial savings compared to traditional health benefit plans.

One of the most appealing aspects of HRAs is their flexibility. Employers can customize the arrangements to cover a broad range of expenses, choose how much to contribute, and decide which employees are eligible. This makes HRAs an excellent tool for tailoring benefits to meet the diverse needs of different groups of employees.

Potential Drawbacks

Managing an HRA can be administratively intensive. Ensuring compliance, handling reimbursements, and maintaining accurate records require a robust administrative system or partnership with a capable third-party administrator.

Some employees might find HRAs confusing, especially in terms of determining eligible expenses and understanding the reimbursement process. This confusion can lead to underutilization of the benefits, which diminishes the value of the HRA for employees.

While HRAs present certain challenges, the benefits they offer generally outweigh these drawbacks. Properly managed HRAs can provide flexible, cost-effective health care benefits that are mutually beneficial for employers and employees.

Harness the Benefits of HRAs

Navigating the intricacies of healthcare benefits doesn’t have to be challenging. Health Reimbursement Arrangements (HRAs) offer a flexible, tax-advantaged solution that can be customized to meet the diverse needs of both employers and employees. By understanding the types, benefits, compliance requirements, and practical considerations of HRAs, businesses of any size can enhance their benefits offerings and provide significant financial savings.

Embrace the power of HRAs and transform how you manage healthcare costs. Your employees will thank you for the thoughtful approach to their well-being.

Get Started with Your HRA Plan!

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