City of Augusta Kansas

 

 

The Health Reimbursement Account (HRA) is an Employer-funded plan that reimburses employees for incurred medical expenses that are not covered by the company's standard insurance plan.

 

By increasing our deductibles and co-insurance, we are able to keep our premiums down. To keep employees from having to carry the whole burden of the higher premiums, we will have a $500 fund to draw from, if we need it.

 

Deductibles:

·         $1500 for a single policy

·         $3000 for a family policy

Co-insurance:

·         $1000 for a single policy

·         $2000 for a family policy

 

Yes and no; doctor’s visits are now $25 per visit; but specialist co-pays have gone down to $25 per visit.

There are three levels of prescription co-pays

·         $15 Generic

·         $30 Formulary

·         $45 Non-Formulary

 

Any medical deductible or co-insurance for you and your dependents – excluding doctor’s visits co-pays and prescriptions.

 

We’ll consider the costs for a CAT Scan. Let’s say the contracted amount is $2000. Also, let’s say you haven’t had any medical expenses in the year so far.

·         The first $1500 is your deductible; the insurance company pays 80% of the balance. So, your co-insurance is $100 (20% of $500)

·         Your initial balance is $1600 for the CAT Scan.

o   ($1500 deductible and $100 co-insurance)

·         You can use your whole HRA amount of $500, leaving you a balance of $1100 out-of-pocket.

It’s the amount that you owe for the medical services you received. It includes:

·         Deductible

·         Doctor’s Visit Co-pays

·         Co-Insurance

·         Any additional Co-Pays, such as the $100 Co-pay for going to the Emergency Room

On our plan, employees pay 20% of contracted services up to the maximum amount

·         Single Plan Maximum Amount – $1000

·         Family Plan Maximum Amount - $2000

Once you have hit your maximum amount, the plan pays at 100%

  

·         If your medical bill is $5000, you will pay your deductible of $1500, which leaves a balance of $3500.

·         You will also pay the 20% co-insurance amount of $700 (20% of 3500).

No. The Health Reimbursement Account can only be used for your health insurance medical deductibles and co-insurance.

·         You will receive a packet in the mail with information about the Health Reimbursement Account, including instructions on how to submit invoices or Explanation of Benefits (EOB).

·         You can submit by mail, fax, or online.

·         If you have set up direct deposit with Direct Pay, you should see your funds deposited within 2-5 days.

 

No. Just send the invoice and the EOB (Explanation of Benefits). If you send it in early, you will have your reimbursement before your due date on the invoice.

Your account can be accessed online at any time. Instructions will be in your employee packet.

 

·         The City is funding your account to help with the deductible and co-insurance medical expenses that you incur during the year.

·         At the end of the year, if you have not had to spend all $500, it stays with the City.

·         The leftover amount at the end of the year will help the City fund the account the following year.

·         A lot of people won’t reach their allotted amount. However, if they do, it is there for them to use as long as they use it within the year.

 

No. All 2012 reimbursements are for services received in 2012.  But, if you have not used up all your 2011 HRA, you can still get a reimbursement from 2011 - as long as you send in your request by 3/31/2012.

No. All reimbursements (money received) are tax-free.

 

No. Only the employer can contribute to the HRA account. However, you can put money into a Flexible Spending Account with AFLAC for additional tax-free medical reimbursements.