NY HRA Fund

HRA General Information

The Health Reimbursement Account (HRA) provides reimbursement for certain IRS-approved over-the-counter products and out-of-pocket expenses incurred by eligible participants. Out-of-pocket expenses refer to the amounts that remain the participant’s responsibility after all available insurance options have been exhausted.

It’s essential to understand that all available insurance must be utilized before any reimbursement from your HRA can be considered. These out-of-pocket expenses are clearly outlined on the Explanation of Benefits (“EOB”) you receive when insurance pays. Additionally, an expense will not qualify as an Eligible Medical Expense if it is specifically excluded from coverage under the terms of the Health Plan.

Requirements to Use the HRA Account

• Must be an Active Member or a Pensioner with an HRA balance on their Pension effective date to utilize the HRA Account.
• An HRA Enrollment Form must be on file before you will be able to access your HRA. Any dependent not listed on the form will not be eligible to receive reimbursements. If you have any change in a dependent’s status or need to enroll a new dependent, please contact the Fund office to obtain a new form.
• For those members who opted out before 4/1/24, you will be required to submit an Attestation Form annually to confirm that you are enrolled in another employer-sponsored group health plan that meets the minimum value standard of the “Affordable Care Act” to retain access to your HRA.
• Members must provide all the proper documentation to support their claim for reimbursement. Proper submittal of documentation to support a reimbursement request will help ensure your claim is processed quickly and efficiently.
• All Claims must be within the Timely Filing window of one year from the date of service or date insurance paid for a service.
• Minimum Reimbursement submission is $100 per claim. Each January and July, reimbursement submissions of under $100 will be accepted.
• Active Members must be in good standing with your Local Union and must have contributions from a contributing employer within the last four months or be signed to their Local’s out of work list.
• Non-Medicare retirees with a Pension effective date of 4/1/24 or later must be in good standing with your Local Union.
• Medicare eligible retirees with a Pension effective date of 1/1/24 or later must be in good standing with your Local Union.
• Under No Circumstances can you receive reimbursement for expenses that were incurred before the date you became a Participant in the Health Plan.

Tips on what’s Eligible and what’s not

When reviewing guidance on eligible HRA claims, it’s clear that each case is highly situational. A specific product may be considered eligible for one participant because of an existing letter of medical necessity, while another participant might be denied for the same product due to a lack of supporting documentation. This variability emphasizes the need for an individual assessment during the claims process. If you have any questions about which expenses are reimbursable, please don’t hesitate to contact the HRA department for clarification. We’re happy to help.

For a detailed list of Eligible and Ineligible Services and Products, and other requirements for reimbursement, please see the below:

HRA List of Services and Products

Features of the HRA you should know about:

• Once your HRA balance exceeds $1,000, your HRA is activated for use. If you are interested in obtaining a debit card for point of sale out of pocket medical expenses, please call the Fund Office, and you will receive two HRA debit cards sent to your registered address.
• The HRA debit card is designed to be used ONLY for prescription and medical copays, coinsurance and deductibles. It cannot be used for over-the-counter medications or for optical/dental providers.
• Members may submit for the reimbursement of eligible over-the-counter products or optical/dental services by uploading via the mobile app, consumer portal, or by submitting a standard paper claim. For more information on the mobile app click here. For the consumer portal click here.
• Questionable charges on the HRA Debit card may lead to a request for more information (RMI). In this case, the participant will receive a letter requesting additional documentation and will have 45 days to submit the required documents to the HRA department to support the charge. Failure to respond will result in the need to repay the service to the Health Fund and the suspension of your HRA debit card until the repayment is made. Future mobile uploads and paper claim reimbursements will be used to reimburse the Fund.
• Participants with an outstanding repayment will not be offered the Health Plan’s retiree coverage until either the repayment is satisfied, or a repayment agreement is signed.
• Only the Union Member, their Spouse, and any eligible dependents under the member are eligible to utilize the HRA account. Services rendered or products purchased for individuals not listed as eligible under the Health Plan are deemed non-reimbursable.

Service Areas Based on Locals:
Upstate
Phone: (716) 839-7132 Ext. 3880
Locals: 276, 277, 1163, 291 (Adirondack)

Downstate
Phone: (631) 952-9700 Ext. 3209
Locals: 290, 279, 291 (Albany)