Your Business is unique, so should your HRA...

We specialize in designing and administering Integrated HRA plans.  Each of our plans are custom tailored to your specific needs.  While most administrators just offer the option of a  dollar amount to be put into an HRA, or paying a portion of an employees deductible, RP Riley shines in utilizing a Defined Benefit HRA .  You are in control of what benefits you want, choose any insurance company, select how you want your plan administered, and allowed to make changes and adjustments during the year.

Below are options for each type of HRA- (all plans will be designed per your requests)

RP Riley HRA Types

A Stand Alone HRAs by definition do not integrate with a group health insurance plan.  These plans are commonly used for Dental and Vision Expenses or for Retire Only plans.

*Due to the Affordable Care Act (ACA), most stand-alone HRAs have been prohibited since 2014.  New law has created a special exception for small employers that are not subject to the ACA’s employer shared responsibility rules. Instead of offering a group health plan, small businesses may use a QSEHRA to reimburse employees’ out-of-pocket medical expenses, including their premiums for individual health insurance coverage, on a tax-free basis.    QSEHRAs may be adopted for plan years beginning on or after Jan. 1, 2017

Here are some common uses (this can be completely customized to your needs):

  • In lieu of purchasing Dental or Vision Insurance– design your own set of benefits or reimbursement levels.
    • Example:  A. Create your benefit-    B. Set a defined dollar amount such as $500 per yr to use on any dental/vision expense.
  • To pay for expenses not covered by current dental/vision insurance
    • Example:  Deductibles, Co-Insurance, Adult Ortho, Rx sunglasses, Rx safety glasses or readers, etc.
  • To Increase benefits Add additional funds for Ortho coverage, increase benefits for major services or annual maximums. Increase allowances for vision frames or lenses.

Your plans can have dental, vision, or both…it’s completely up to you. You can

either use a  Defined Benefit approach and create your own plan (similar to what an insurance company does) or use a Defined Dollar approach, setting a maximum dollar and allowing employees choose how they use it. Our team is flexible in working with your needs.

Administration Pricing:

$6 per month, per enrolled employee

One Time Set up Fee: $500 Document fee & $5 per enrolled employee

Set up fee includes: Employer Documents, SPD, and Basic Employee Kits.

rxThe Rx Only plan does need to be integrated with a qualified group health plan. Our Rx Only HRA is great for employers who have a High Deductible Health Plan (HDHP) where the deductible also applies to the pharmacy benefit.  In this plan you will have the use of our Rx Card to help give a convenience and upfront benefits for your employees at the point of purchase of their prescriptions.

We are able to offer a true secondary payer prescription drug card. THIS IS NOT JUST A DISCOUNT CARD. The card coordinates with your insurance carrier, so there is no overlap in payments.  Our arrangement also allows the drugs purchases to automatically accumulate toward the high deductible of the insurance plan.  Also, unlike a debt card, our Rx Card does not need to be  completely pre-funded. (a small deposit is required usually around $500 total for the entire group)

As with all of our HRA plans, you custom design they benefits and maximums you want to have. Here are a few examples:

Co-Pay Option-  $15 generic/$35 preferred brand/$50 brand- $1,000 annual maximum. (In this case and employee would only pay their co-pay at the time of picking up the Rx until they either use their annual maximum or their high deductible has been met..which ever comes first)

Co-Insurance Option- 50% reimbursement- $1,000 annual maximum (This option, the employee would pay for 50% of the cost of the Rx at the time of pick up, they also pay this co-insurance until the benefit maximum is exhausted or the high deductible has been met)

Co-Pay using Cost Basis-  This plan is not often chosen, however we can use a cost basis rather than a generic/brand basis:  Cost of Rx $1-100= copay of $15  Cost of Rx $101-250= copay of $35  Cost of Rx 251+= $50 copay.

The Rx card is accepted at more that 64,000 chain and independent pharmacies nationwide!

Administration Pricing:

$4 per month, per enrolled employee

One Time Set up Fee: $500 Document fee & $5 per enrolled employee

Set up fee includes: Employer Documents, SPD, and personalized ID cards.

Simple yet effective!  This integrated HRA can be either a defined dollar or defined benefit plan.  Whether you purchase a PPO or a HDHP insurance plan both work great with a simple HRA.

Examples of Defined Dollar plans-

  1. $1,200 annual maximum used for any IRS Section 213  eligible expenses. (This annual maximum could also be capped at $100 per month to a annual max or available all at once.)
  2. $2,000 annual maximum used only for reimbursement of deductible and/or Co-Insurance amounts.

Examples of Defied Benefit plans-

  1. Simple Plan A Sample
  2. Simple Plan B Sample
  3. Simple Plan C Sample
  4. Simple Plan D Sample
  5. Simple Plan E Sample
  6. Simple Plan F Sample

* Above are examples only, all plans are customized based on your needs and the insurance plan/deductible you have purchased.

Administration Pricing:

$8 per month, per enrolled employee

One Time Set up Fee: $500 Document fee & $10 per enrolled employee

Set up fee includes: Employer Documents, SPD, SBC, Full Employee Kit.

This is where creativity meets benefits!  A Fully Customized plan is our most popular type of Integrated HRA.  You no longer are confined by what plans are offered by an insurance company or lacking plan options with other HRA administrators.   We love being creative to make a plan you really want and stay within your budget.  Do you want to offer a office copay for a limited number of visits..No Problem!  Need to cap how much you want to spend on Rx claims but still have an RX card..No Problem!  Would like to exclude specific services from your HRA..No Problem!  Nothing is to complex for us to administer.

Below are some examples of plan designs-

  1. Complex Plan A Sample
  2. Complex Plan B Sample
  3. Complex Plan C Sample
  4. Complex Plan D Sample
  5. Complex Plan E Sample

* Above are examples only, all plans are customized based on your needs and the insurance plan/deductible you have purchased.  If you need help reading or understanding a sample chart or have design question CALL US we love to help!

Administration Pricing:

Please call our sales office for pricing.

HRA Basics

What are HRAs?

Health reimbursement arrangements (HRAs) are plans designed to help employers and employees lower health care costs. Allowed under sections 105 and 106 of the Internal Revenue Code, HRAs enable employers to reimburse employees for out-of-pocket medical expenses not covered by insurance. HRAs are often combined with high-deductible health plan coverage.

HRA Advantages

Employers benefit from offering HRAs by reducing insurance costs and restructuring health benefits.  By moving employees to high deductible health plans (HDHP), employers reduce their premiums and design an affordable plan of benefits. With RP Riley employer only pays un-insured expenses, if and when they would occur. (No pre-funding accounts).

HRA plans offer tax advantages to both the employer and employee.  For the employer, the benefits they offer the employee are tax deductible.  This transfers dollars for the employees’ benefit without incurring FICA, workers compensation, unemployment or other employer related payroll taxes.  For the employee, the plans payments are not considered to be taxable.

RP Riley is extremely flexible and can customize an HRA plan to suit the employer’s exact situation.  Th employer can establish maximum amounts for reimbursement, choose whether or not to offer drug cards, or utilize co-pays, and reimburse only benefits they choose to fund.

Expenses not Eligible for Reimbursment through an HRA

The following expenses are considered ineligible for HRA reimbursement:

  • Medical expenses not defined as eligible under an employer’s plan
  • Medical expenses that do not meet the definition of “medical care” under Internal Revenue Code section 213(d)
  • Medical expenses incurred by an employee, employee’s spouse or any eligible dependents prior to the effective date in the program
  • Medical expenses that can be reimbursed to an employee through another source, such as group health insurance

Basic HRA Rules

Only Employer Contributions – HRAs must be funded solely with employer contributions. No direct or indirect employee contributions are allowed.

Reimbursements for Certain Individuals Only – An HRA may reimburse medical care expenses only if they were incurred by employees or former employees (including retirees) and their spouses and tax dependents. Effective March 30, 2010, this also includes children who are under age 27 as of the end of the taxable year. HRA coverage must be in effect at the time the expense is incurred.

No Cash-Out of Unused Amounts – If using a defined dollar benefit type, unused HRA amounts cannot be cashed out and can only be used for reimbursement of medical care expenses.

COBRA – COBRA applies to an HRA.

Coordination with Health FSA – HRA may be coordinated with a health FSA, the HRA pays first and the health FSA pays last.

How does the ACA impact HRAs?

Before 2014, employers were able to offer HRAs either with another group health plan or without a health plan. (that is stand-alone HRAs).  Also before 2014, HRAs were sometimes used to help employees pay for the cost of individual insurance policies on a tax-free basis.  Effective for plan years beginning on or after January 1, 2014, the ACA’s market reform apply to HRAs as follows:

Stand-alone HRAs (which do not meet the requirements for integration) are not permitted, unless the HRA qualifies for an exemption under ACA.  For example, retiree-only plans, dental or vision plans.

Effective for 2014 plan years, employers cannot offer a stand-alone HRA for employees to purchase individual coverage.

 

What We Do

  • Assist you with plan design, documents and budget analysis to help find a plan that protects your budget and your employees
  • Monitor activities on each employee account
  • Evaluate employee expenses submitted for reimbursement, protecting you from non-compliance due to improper reimbursments
  • Process employee claims of incurred expenses
  • Prepare checks and EOBs for disbursement according to the schedule you choose
  • Provide a dedicated customer services representative to your account
  • Monitor your plan to ensure that your plan meets all compliance requirements
  • Analyze your group's history at renewal time and provide a detailed accounting of your groups plan use
  • Provide an easy to understand packet of detailed information to all your enrolled employees

FAQ

Can I keep my current Insurance Company?

Of Course!  Many insurance companies offer plans which coordinate will with our HRA plans.  We will work with you, to obtain a solution that best fits your needs.

How often are reimbursments made?

Reimbursements an be paid once a month, twice a month, or weekly.  The choice is yours.

How do I fund the HRA?

The plan is funded on a Pay-as-You Go basis, not pre-funded.  Unlike conventional health plans, where you pay premium before any claims occur, with our HRAs, you only play claims after they occur, and only if they occur.

The only exception to this is if you have our Rx Card, we do ask you set up a small deposit.  (In most cases this amount can be as small as $500.)

How do employees submit a claim?

This information will be found in the Employees Kit.  However, you simply send us a copy of the Explanation of Benefits (EOB) from your insurance carrier along with a claim form.  You can send them to RP Riley by fax, email, or regular mail.

How Do Employees know their Claim is Processed?

The employee will receive an EOB from us showing how the claim was processed along with a reimbursement check, if applicable.

How do I use the Rx Card?

  • You/dependents present BOTH your primary insurance card and the Rx Care card to the pharmacy
  • The Pharmacist will submit the prescription claim to the primary card first and the cost of the Rx will apply to your deductible. They will then submit the prescription to Rx Care Card for payment.
  • You will be responsible only for your cost share of the prescription