HRA 5500
Annual IRS return/report for employee benefit plans
Category: HRA
HRA 990
IRS form for annual returns
Category: HRA
HRA Attestation Form
This should have been mailed out to you. You can download it, fill it out, and upload it in our secure HRA portal.
Category: HRA
HRA Claim Form - Recurring and Third Party
If we pay your monthly insurance premium on a recurring basis, use this document. Preferred method: After filling out, you can send it to us on our secure HRA web portal.
HRA Continued Coverage for Disabled Child
If your child is over 26 and is disabled, they can still be covered under the parent's HRA. Preferred method: After filling out, you can send it to us on our secure HRA web portal.
HRA Dependent Change Form
If you have to add a dependent, the easiest route is to enter the information directly in the HRA web portal. When there is a new marriage, we need a copy of the marriage certificate. Please note: for a baby, we don't need any additional paperwork along with this.
HRA Legal Name Change Form
Preferred method: After filling out, you can send it to us on our secure HRA web portal. Please note: If marriage, provide marriage certificate. If divorce, provide divorce decree.
HRA One-Off Claim Form
Most often, this is the one you need, for one-off health expenses you need a payment for. Preferred method: After filling out, you can send it to us on our secure HRA web portal.
HRA PHI Release Form
Authorization to release personal health information. Preferred method: After filling out, you can send it to us on our secure HRA web portal.
