A Member Pays First Health Reimbursement Arrangement (HRA) is a benefit where you pay for eligible expenses up to a set out-of-pocket threshold before the plan begins reimbursing you.
Once you reach your out-of-pocket threshold, the plan pays for eligible expenses up to your reimbursement balance. Your employer sets both your out-of-pocket threshold and reimbursement balance amounts, which are displayed in your benefit details.
This article explains how to view your claims, understand claim statuses, and track your spending progress toward your out-of-pocket threshold and reimbursement balance in Health Wallet.
How your HRA works
Because your HRA is set up to be member pays first, it has two phases:
Phase 1: You pay (before out-of-pocket threshold)
You pay 100% of eligible expenses until you reach your out-of-pocket threshold. For example, if your out-of-pocket threshold is $750, you'll pay for the first $750 in eligible expenses.
Claims you submit during this phase are approved but marked as "Out of Pocket"; the plan doesn't reimburse them. Keep in mind that claims marked "Out of Pocket" count toward your out-of-pocket threshold.
Phase 2: Employer Pays (After Out-of-Pocket Threshold)
Once you've reached your out-of-pocket threshold, the plan reimburses 100% of eligible expenses up to your reimbursement balance. For example, if your reimbursement balance is $6,750, the plan will reimburse up to $6,750 in additional expenses after your out-of-pocket threshold is met. Claims submitted during this phase are marked as "Paid."
Example:
Your HRA has a $750 out-of-pocket threshold and $6,750 reimbursement balance:
You submit a $300 claim: Approved, but marked "Out of Pocket" (you've spent $300 toward threshold)
You submit a $450 claim: Approved, but marked "Out of Pocket" (you've spent $750, reaching your threshold)
Your next $600 claim: Marked "Paid" by plan (applies to your $6,750 reimbursement balance)
Partially paid example: Your first claim is $1,200: Approved, but marked “Partially Paid.” $550 would be paid out after you have reached your $750 out-of-pocket treshold.