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Small Business Employee Benefits and HR Blog

Integrated Health Reimbursement Arrangements (HRAs) - An Overview

March 11, 2014

This article provides an overview of Integrated Health Reimbursement Arrangements (HRAsand how employers use them to achieve health benefits cost savings.

A Health Reimbursement Arrangement (HRA) is an IRS-approved, employer-funded medical expense reimbursement plan. An HRA allows an employer to reimburse employees tax-free for eligible out-of-pocket medical expenses and individual health insurance premiums - so long as the plan complies with new health reform regulations.Integrated_HRAs

Integrated Health Reimbursement Arrangements (HRAs)

An Integrated HRA is an employer-funded medical reimbursement plan linked with a group health insurance plan - usually a high-deductible plan.

The Integrated HRA is offered only to those at the company who take part in the group health insurance plan, as it is a supplement to help employees with their deductible costs.

With an Integrated HRA, the company sponsors a group health insurance plan but is looking to lower the cost of premiums while keeping employees' coverage (risk) the same.

  • First, a company would purchase a high deductible health plan to achieve savings with lower premiums (for example, switch from a $500 deductible to a $2,500 deductible health plan).  

  • Second, the company would offer an Integrated HRA to cover the difference between the old and new deductible (in this example, $2,000 annually). 

The company realizes savings because employee utilization of the HRA tends to be 30-50% depending on the plan design.

Employees use the Integrated HRA to be reimbursed for out-of-pocket medical expenses. With Integrated HRAs, it is common for the plan to only reimburse deductible or co-insurance expenses that are also covered under the group health insurance plan. An Explanation of Benefits (EOB) is typically required with each reimbursement request.

To summarize, generally with an Integrated HRA:

  • The company sponsors a high-deductible health plan (HDHP).

  • The company sponsors an Integrated HRA plan to reimburse out-of-pocket medical expenses (often just deductible/co-insurance expenses covered by the HDHP).

  • Allowances are given annually, and there is no rollover of unused funds year to year.

Integrated HRAs are also commonly known as a Deductible-Only HRA or a GroupHRA.

How Health Reform Impacts Integrated HRAs

Health reform has brought sweeping changes to the health insurance industry, including how employers can use HRAs.  Integrated HRAs are generally compliant in 2014.

However, employers offering (or planning to offer) an Integrated HRA should work with their broker to confirm that their group health insurance plan, combined with the Integrated HRA, meets all health reform requirements. For example, see: Integrated HRAs - Minimum Value and Affordability Calculations.

Other Types of Health Reimbursement Arrangements (HRAs)

In addition to Integrated HRAs, HRAs are used in the following ways:
  • Retiree HRAs

  • Small Business HRAs

  • Limited-Purpose HRAs (ex: dental only, vision only)

Click here to read more about how the Small Business HRA can be used.

Questions about Integrated HRAs? Leave a question below and we'll help answer it.

Learn more about the small business HRA
Everything you need to know about small business health reimbursement plans
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