Use this article to set up an HRA benefit and add coverage levels that match your organization’s plan documents. Coverage levels determine the amount of funding each member receives based on their enrollment tier (e.g., individual, individual plus one, or family).
Note for admins managing multiple organizations
Choose the appropriate organization or division from the Organizations tab before following the steps below.
Configure the HRA benefit
Select the Benefit Builder from the navigation menu.
Select Edit Program for the benefit you want to set up.
Configure the plan details to match the organization's plan document.
Set the payout structure for your HRA
When configuring your HRA benefit, you'll choose a payout structure that determines how claims are reimbursed. There are two supported payout structures:
Employer pays
The plan reimburses eligible expenses at 100% up to the plan limit. Members do not have an out-of-pocket deductible.
Member pays first
Members must pay for eligible expenses up to a set deductible amount before the plan begins reimbursing claims. Once the member reaches the deductible, the plan reimburses expenses at 100% up to the plan limit.
How member pays first works
A member pays first HRA has two tiers of coverage within each coverage level:
Tier 1 (Member Responsibility): Members pay 100% of eligible expenses up to the deductible. Claims during this tier are approved but marked as Out of Pocket.
Tier 2 (Plan Responsibility): Once the member reaches the deductible, the plan reimburses 100% of eligible expenses up to the plan limit. Claims during this tier are marked as Paid.
Example:
An HRA with a $500 deductible and $2,000 plan limit:
Member submits $300 claim: Approved, "Out of Pocket" (member has paid $300 toward deductible)
Member submits $250 claim: Approved, "Out of Pocket" (member has paid $550, exceeding deductible)
Next $50 from second claim: "Paid" by plan (applies to plan limit)
Note for org and division admins
You can set up Member Pays First HRA benefits in the Benefit Builder. However, you cannot view or approve claims for these benefits. Contact your partner admin if you need to approve or review member claims.
Adding coverage levels to your benefit plan
Go to the Coverage section in the Benefit Builder.
Choose the payout frequency in the Frequency dropdown menu.
Choose the 1st Pay Date.
Name your Coverage Level (e.g., IND, IND +1, FAM).
For Employer Pays HRAs:
Add Coverage Amount for each Coverage Level.
For Member Pays First HRAs:
Define the Member Pays Threshold (the deductible amount members must pay before the plan reimburses).
Define the Plan Limit (the maximum amount the plan will reimburse after the deductible is met).
The system calculates the employer's maximum total responsibility for each coverage level.
Continuing setup:
(Optional) Choose Add Coverage Level to add another coverage level.
(Optional) Drag and drop your Coverage Levels to order them however you'd like.
(Optional) Select whether or not this plan has a carryover amount.
Select Save.
Language note
Maximum Employer Liability refers to the total amount the employer is required to reimburse in that coverage level.
Note
The benefit frequency defaults to Annual, and the 1st Pay Date defaults to the plan start day. For other benefit frequencies, fill out the appropriate dates.
Enrollment spreadsheet note
Because the name of your coverage level is customizable, the number associated with each coverage level is what you will input when creating your Enrollment Spreadsheet in the HRA_COVERAGE_LEVEL column.
Add benefits to organizations
Select the organizations you want to add to this benefit
Select Add Selected
Review your selections on the confirmation screen
Select Create Benefit Offering
Coverage Level for HRAs
When enrolling members into an HRA, you must select a coverage level for the member. If the member’s status is still Pending Enrollment, you can update their coverage level by selecting the more options menu for that member and selecting Update Coverage.
For Member Pays First HRAs, the coverage level you select determines the member's deductible and plan limit. These amounts are automatically applied when claims are submitted and evaluated.