Frequently Asked Questions: Health Reimbursement Arrangement (HRA)

What is a Health Reimbursement Arrangement or HRA?

Your employer has established a Health Reimbursement Arrangement (HRA). Depending upon how the HRA was designed, it will reimburse covered employees for different types of medical expenses.

• The HRA may reimburse medical expenses not covered or reimbursed under the group health plan(s) sponsored by your employer: and/or
• The HRA may reimburse medical expenses referred to as “213(d) expenses.” These are medical expenses that are allowable under section 213(d) of the Internal Revenue Code. Examples of 213(d) medical expenses include dental or vision expenses.

The plan document/summary plan description controls what is actually covered under your HRA. Please refer to EGA’s website(www.ega-inc.com) to view plan information online or contact your employer for a copy of this document.

How do I submit a claim?

Claim procedures are unique to each HRA. Generally, after the group health plan has paid or denied the expense, you submit a claim form, the Explanation of Benefits (EOB) provided by the group health plan and a copy of the medical invoice to EGA for processing. (See below for procedures that apply to Significa Insurance Group.) Please note, a copy of the medical invoice is not always required; refer to your plan document for specific instructions.

Claims forms are available on EGA’s web site at www.ega-inc.com. Click on “Member” and then “Forms.” In addition, you can obtain a claim form from your employer or by contacting EGA’s customer service department at 717-581-1300 or 800-433-3746.

Please attach the required information to the HRA claim form and forward to EGA as follows:

Address:	EGA, Inc. P.O. Box 7777 Lancaster, PA 17601-7777
Email:	customerservice@ega-inc.com Please note, you should not submit information via email without encryption in order to assure your privacy.
Fax:	(717) 581-8379

How long does it take to process a claim?

EGA is committed to a claim turn around time of 5 business days. After processing, claim funding information is presented to the employer. Checks are generally issued the week following processing. When your claims are processed, they can be viewed on EGA’s member web site.

As part of EGA’s quality assurance program, a claim you submit may be randomly selected for a pre-check audit. Audited claims will be released for check processing as quickly as possible, but no later than 3 days from the selection date.

What is a member ID?

This is the unique alpha-numeric member identification number that is assigned by EGA at enrollment. The first three characters are alpha, followed by six numbers. The member ID can be located on EOBs and other correspondence generated by EGA. When you contact our customer service department you will be asked for this information. If you do not have it available, you can provide your Social Security Number. If your spouse is contacting us, he or she will need to provide your Social Security Number. This verification is necessary to assure that we protect the privacy of our members.

HRA with Significa Insurance

If you are covered under a Significa Insurance Group policy, and your employer has contracted with EGA to administer the HRA, EGA will automatically process claims under the group health plan and HRA. Therefore, you will not be required to submit claims separately to the HRA for reimbursement. However, if your HRA covers expenses not applicable to the group health plan (dental/vision), please follow the claim procedures described in your HRA plan document (see above).

Your Significa group health plan EOB will be issued prior to your HRA EOB. Please read the messages on the first EOB carefully to determine whether charges will be considered under the HRA.

Payment can be issued directly to the provider.