FAQs

Got Questions?  We have answers!  Select a topic below to see all the FAQs available.  Are you unable find an answer to your question?  Contact us!


General

Where is Administrative Solutions located?

ASi is located in the heart of Fresno, CA.  100% of our employees work in the same office, no offsite call centers and no outsourcing.

Who Do I Call if I Have Questions?

You can always fill out a message on our Contact Us page or call us directly at 866-777-1320 or 559-256-1320. You will get a live person every time you call with no IVR menu options!

Health Reimbursement Arrangement

What is an HRA?

HRAs allow your clients to help offset their employees’ out-of-pocket healthcare expenses.  An HRA is not a stand-alone health insurance plan.  Instead, it is an account that your client funds which offers the client’s employees an allowance of tax-free money.

When Are Employees Eligible to Join the Plan?

Employees are eligible to join the plan based upon the terms in the Plan Document and Summary Plan Document.  Typically, employees may join the plan at the same time they become eligible for your client’s group medical plan.  If eligibility is triggered due to a status change event (birth, marriage, divorce, etc.) then employees have 30 days to join after they become eligible.

Flexible Spending Account

What is an FSA?

A Flexible Spending Account is an employee contributed account that allows them to set aside tax-free money that can be used throughout the year for qualified healthcare or childcare expenses.

When Are Employees Eligible to Join the Plan?

Employees are eligible to join the plan based upon the terms in the Plan Document and Summary Plan Document.  If eligibility is triggered due to a status change event (birth, marriage, divorce, etc.) then employees have 30 days to join after they become eligible.

What Expenses Are Covered?

Healthcare FSA

Healthcare FSAs covers a variety of healthcare expenses including, but not limited to:

  • Deductibles & Co-Pays
  • Prescription Drugs
  • Dental & Orthodontic Services
  • Eyeglass, Contacts & Eye Surgery
  • Chiropractic Services
  • Mental Health Care
  • Smoking Cessation Program

For a complete list of eligible services, please visit the complete list here.

Limited Purpose FSA

Limited Purpose FSAs are only eligible for dental and vision related expenses.

Dependent Care Assistance Program

What is the Dependent Care Assistance Program?

The Dependent Care Assistance Program allows participants to set aside pre-taxed dollars for eligible childcare expenses.

Learn more here.

What Expenses Are Covered?

DCAP benefits covers participant childcare expenses incurred while your client’s employees and their spouse are both working.

For a complete list of eligible services, please visit this link.

Commuter Benefit Accounts

What Are Commuter Benefit Accounts?

Commuter Benefit Accounts are benefit plans for mass transit (traveling to and from work) and work-related parking expenses for employees.  They are an employee-driven accounts in which employees can contribute pre-tax dollars into an account to help pay for their commuting expenses.

What Expenses Are Eligible?

The Transportation benefit covers participant’s work-related mass transit expenses including, but not limited to:

  • Subways, streetcars, and commuter trains
  • Buses
  • Ferries
  • Vanpool
  • Rideshare, including UberPOOL and Lyft Line

Ineligible expenses include non-work-related expenses and individual transportation services like a taxi or a driving service.

The Parking benefit covers participant’s work-related parking expenses including:

  • Parking lots/garages near work
  • Parking lots/garages near mass transit stations

Self-Funded Dental and Vision Benefits

What are ASi Self-Funded Dental and Vision Plans?

With our Dental and Vision plans, your client completely funds all dental and vision claims for their employees.   Self-funded dental and vision plans allow an employer to only pay for claims that are actually incurred. Under traditional fully insured dental and vision plans, an employer must pay premiums for a participating employee even if they do not use the plan.

What is a Share of Costs?

A share of costs is a concept that allows employers to make employees financially responsible for a portion of their benefit plan.  For example, if the benefit amount per employee is $100, your client could design a share of cost plan of 50/50, where they would pay 50% of the $100 and their employee would pay 50% of the $100.  That means they would both owe $50.

What Dental Networks Does ASi Offer?

With our dental plans, we offer several different networks to choose from to give your client’s employees a bigger discount when seeing a contracted dental provider.  Below are the networks your client can choose from:

COBRA Administration

What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed in 1985 to help reduce the rate of uninsured Americans.  This Act forces employers to offer insurance continuation to anyone who would otherwise lose coverage due to a qualifying event.

What Are Some Examples of COBRA Eligible Group Health Plans?

Some basic examples of COBRA eligible health plans are: Medical, Dental, Vision, Flexible Spending Accounts, Health Reimbursement Arrangements, Employee Assistance Programs (not all are eligible), Prescription Drug Plans, and Medical Expense Reimbursement Plans.

What is an Initial Notice? What is a Qualifying Event Notice?

Of all the COBRA notices there are two that are of the utmost importance:  The Initial Notice and the Election (Qualifying Event) Notice.

Initial Notice
The Initial Notice is a letter to be sent when an active employee is enrolling in any group benefit plan sponsored by the employer and it is a COBRA eligible plan.  This is also called a General Rights Notice.

Qualifying Event Notice
The Qualifying Event Notice is a letter to be sent when an active employee on a COBRA eligible group benefit plan is losing benefits due to one of the COBRA triggering events.  These events are listed under our COBRA page.  This notification is also called an Election Notice or Specific Rights Notice.

What are COBRA Qualifying Events?

COBRA qualifying events are specific events that trigger an individual to lose their group benefit coverage.  Qualifying events determine who the eligible beneficiaries are, and the amount of time COBRA coverage lasts.

Qualifying Events for Employees include:

  • Voluntary or involuntary termination of employment
  • Reduction in hours of employment

Qualifying Events for Spouses and Dependent Children include:

  • Voluntary or involuntary termination of the covered employee’s employment
  • Reduction in hours worked by the covered employee
  • Divorce or legal separation from the covered employee
  • Death of the covered employee
  • Loss of dependent child status under the plan rules (Dependent Children Only)

Covered employees becoming entitled to Medicare (This is a rare occurrence)

Healthcare Benefit Compliance

What is Healthcare Benefit Compliance?

When an employer decides to offer any kind of benefits to their employees there are regulations and federal laws they are required to comply with.  If they do not comply or are unsure how to comply, they could be penalized.

ERISA Health & Welfare

What does ERISA stand for?

Employee Retirement Income Security Act of 1974.

What is the Main Purpose of ERISA?

To protect the interest of employees and beneficiaries who are enrolled in employee benefit plans and to ensure that employees receive the welfare benefits that have been promised by their employers.

Who Must Comply with ERISA?

Applies to all employer-sponsored group health plans, including self-insured and fully insured plans. All private companies, partnerships, and proprietorships, including non-profits, are required to comply.

Who is Exempt from ERISA?

Governmental employers, federal, state and local (city, county, and township) governments. Church plans are also exempt from ERISA.

What are the Essential Elements of an ERISA Health & Welfare Plan?

  • A written plan that describes the benefit structure and guides day to day operations
  • A recordkeeping system to track contributions and benefit payments, maintain participant and beneficiary information, and to accurately prepare reporting documents
  • Documents to provide plan information to employees participating in the plan and to the government

What are the Employer Obligations Under ERISA?

  • Provide plan participant with important information of the plan
  • Fiduciary duties for those who manage assets covered by the plan
  • Setting up and adhering to procedures for employee grievances about the plan, as well as, appeals for those grievances
  • Government reporting on the plan

What are Some Examples of Health and Welfare Benefits Subject to ERISA?

  • Medical and Prescription drugs
  • Dental and Vision
  • Disability
  • Life and Accidental Death and Dismemberment
  • Long Term Disability and Short-Term Disability

How is ERISA Enforced?

The Department of Labor’s Employee Benefits Security Administration and the Treasury Department’s Internal Revenue Service administers enforces ERISA.

What Happens if I Don’t Adhere to ERISA?

  • Employee lawsuits.
  • Department of Labor enforcement actions and penalty assessments.
  • IRS enforcement actions and penalty assessments.
  • Certain penalties for specified ERISA violations may be assessed.
  • These penalties are adjusted annually for inflation and some examples are below:
Description of Violation 2019 Penalty 2018 Penalty
Failure or refusal to file a Form 5500 Up to $2,194 per day Up to $2,140 per day
Failure to provide documents and information requested by the DOL Up to $156 per day, not to exceed $1,566 per request Up to $152 per day, not to exceed $1,527 per request
Failure to provide reports to certain former participants and beneficiaries & failure to maintain records Up to $30 per day Up to $29 per day
Failure by an employer to inform employees of CHIP coverage opportunities Up to $117 per day Up to $114 per day
Violations of the Genetic Information Nondiscrimination Act (GINA), such as establishing eligibility rules based on genetic information or requesting genetic information for underwriting purposes Up to $117 per participant per day Up to $114 per participant per day
Failure to provide annual Summary of Benefits Coverage (SBC) Up to $1,156 per failure Up to $1,128 per failure

What is a Form 5500?

A Form 5500 provides federal agencies with information regarding the employer’s plan, its finances, and its operation.

When Must I File a Form 5500?

The Form 5500 is due by the last day of the seventh month following the last day of the ERISA Health and Welfare plan year.  For example, plans that end on 12/31 are required to file the Form 5500 by no later than 07/31 of the following year.

How do I File a Late Form 5500?

There is a late filing program enabling reduced penalties under the Delinquent Filer Voluntary Compliance Program (DFVCP). Eligibility for the DFVCP is limited to plan sponsors with Form 5500 filing obligations who comply with the provisions of the program and who have not been notified in writing by the Department of Labor or IRS of a failure to file a timely form 5500 annual report.

Affordable Care Act

What is the Affordable Care Act?

Affordable Care Act (ACA) is the comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”). The law has 3 primary goals:

  • Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
  • Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
  • Support innovative medical care delivery methods designed to lower the costs of health care generally.

What Forms are Required Under the ACA Information Reporting Provisions?

  • Form 1095-A, Health Insurance Marketplace Statement. The Health Insurance Marketplace (Marketplace) sends this form to individuals who enrolled in coverage through the Marketplace, with information about the coverage, who was covered, and when.
  • Form 1095-B, Health Coverage. Health insurance providers and employer of self-funded health coverage send this form to individuals they cover, with information about who was covered and when.
  • Form 1095-C, Employer- Offer and Coverage. Certain employers (ALEs) send this form to certain employees (full-time employees), with information about what coverage the employer offered and information codes to indicate if they enrolled or waived the offer of coverage.
ACA Reporting

What is the Employer Shared Responsibility Provisions Under the IRS code 4980H of the Affordable Care Act?

The employer shared responsibility provisions were added under section 4980H of the Internal Revenue Code by the Affordable Care Act. Under these provisions, certain employers, called applicable large employers or ALEs, must either offer health coverage that is “affordable” and that provides “minimum value” to their full-time employees and their dependents.  If health coverage is not offered, it could potentially make an employer have to make a shared responsibility payment to the IRS, if at least one of their full-time employees receives a premium tax credit for purchasing individual coverage on a Health Insurance Marketplace.

What is Considered an ALE?

Whether an employer is an ALE and is therefore subject to the employer shared responsibility provisions, depends on the size of its workforce. In general, employers employing at least a certain threshold number of employees (generally 50 full-time employees including full-time equivalent employees in the previous year, which means a combination of part-time employees that count as one or more full-time employees) are ALEs. The vast majority of employers fall below this ALE size threshold and, therefore, are not subject to the employer shared responsibility provisions.

Some employers may meet the requirements using this as a guideline for ACA reporting, however, some employers may also have seasonal employees and qualify for exemptions for those who work less than 120 days within the year and may not be subject to the filling requirements.

Are There Reporting Requirements Related to the Provisions Under Section 6056?

Yes. Employers that are subject to the employer shared responsibility provisions that are an ALE are required to report information about whether they offered coverage to employees. If so, information about the offer of coverage. ALEs are required to send this information to the IRS on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. ALEs are also required to send the Form 1095-C for each full-time employee that the employer made an offer of coverage to. The information on these forms is used to determine whether an ALE owes a payment under the employer shared responsibility provisions and whether employees are eligible for the premium tax credit.

Also, an employer that sponsors self-insured health coverage – whether or not the employer is an ALE – has information reporting responsibilities as a provider of minimum essential coverage. In general, an ALE that sponsors self-insured health coverage will use the same form it uses to report about offers of coverage (Form 1095-C) to satisfy this requirement by filling out an additional section (Part III) for employees and family members who enroll in the coverage. See the Instructions for Forms 1094-C and 1095-C.

Some employers may meet the requirements using this as a guideline for ACA reporting, however, some employers may also have seasonal employees and qualify for exemptions for those who work less than 120 days within the year and may not be subject to the filling requirements.

Do The Employer Shared Responsibility Provisions Apply Only To Large Employers That are For-Profit Businesses or to Other Large Employers as Well?

All employers that are ALEs are subject to the employer shared responsibility provisions, including for-profit, nonprofit (whether or not a tax-exempt organization), and government (federal state, local and Indian tribal) employers.

If Two or More Businesses Have a Certain Level of Common or Related Ownership, are They Combined for Purposes of Determining Whether They Employ Enough Employees to Be an ALE?

Yes. The employer shared responsibility provisions include a rule that also applies for certain other tax and employee benefit purposes (section 414). Under this rule, two or more businesses that have a certain level of common or related ownership generally are treated as a single employer and are combined for purposes of determining whether or not they collectively employ at least 50 full-time employees (including full-time equivalent employees). If the combined total meets the ALE threshold, then each separate business is considered to be part of an ALE and is therefore subject to the employer shared responsibility provisions. This includes any business that does not employ enough employees to meet the ALE threshold on its own. Under this rule, an ALE may be a single employer or a group of related employers treated as an aggregated ALE group, which is a group of employers treated as a single employer under section 414(b), (c), (m) or (o). Each employer that is a member of an aggregated ALE group is referred to as an ALE member.

For example, if an individual owns 80 percent or more of two businesses that are separate legal entities, the total number of full-time employees of that employer is based on the full-time employees (including full-time equivalent employees) in both businesses combined. If the employees in the combined businesses add up to fewer than 50 full-time employees (including full-time equivalent employees) in a calendar year, the employer shared responsibility provisions will not apply to those businesses for the following calendar year.

What Is the Definition of Full-Time Employee for Purposes of the Employer Shared Responsibility Provisions?

An employee is considered full-time if he or she has sufficient hours of service. In particular, for purposes of the employer shared responsibility provisions, an employee is a full-time employee for a calendar month if he or she averages at least 30 hours of service per week or has 130 hours of service in the month (130 hours of service in a month is treated as the monthly equivalent of at least 30 hours of service per week).

There are two methods for determining whether an employee is a full-time employee, a monthly measurement method or look-back measurement method. Please contact the ASi Compliance department for further information about these methods.

What Counts as an “Offer Of Coverage” Under the Employer Shared Responsibility Provisions?

In general, an ALE makes an offer of coverage, that is “affordable”, “minimum value” and “minimum essential coverage”, to an employee if it provides the employee an effective opportunity to enroll in the coverage (or to decline that coverage) at least once for each plan year. Whether an employee has an effective opportunity to enroll is based on all the relevant facts and circumstances. When an ALE offers coverage for a complete month it is only acceptable as a complete “offer of coverage” if the coverage would be provided for every day of that calendar month.

What are the Information Reporting Requirements for Providers of Health Coverage?

The Affordable Care Act added section 6055 to the Internal Revenue Code, which requires every provider of minimum essential coverage to report coverage information by filing an information return with the IRS and furnishing a statement to individuals. The information primarily is used by the IRS to administer – and by individuals to show compliance with – the individual shared responsibility provision in section 5000A.

Who is Required to Report Under Section 6055?

Any person that provides minimum essential coverage to an individual must report to the IRS and furnish statements to individuals, including the following:

  • Health insurance issuers, or carriers, for insured coverage (with certain limited exceptions)
  • Employer plan sponsor of self-insured group health plan coverage, and
  • The executive department or agency of a governmental unit that provides coverage under a government-sponsored program

What Type of Return Must a Health Coverage Provider File with the IRS?

Generally, a health coverage provider must file Form 1094-B and Form 1095-B (or another form that the IRS designates, or a substitute form). However, if the provider is also an ALE Member as defined in the employer shared responsibility provisions under section 4980H and provides coverage to its employees through a self-insured group health plan, the provider must file Form 1094-C and Form 1095-C (or another form that the IRS designates, or a substitute form), instead of Forms 1094-B and 1095-B, to report information with respect to its employees.

When Must an ALE or Health Coverage Provider File the Information Return with the IRS?

An ALE and provider of health coverage generally must file the information return and transmittal form with the IRS on/or before February 28th  (March 31st  if filed electronically) of the year following the calendar year.

Must an ALE or Health Coverage Provider File the Return With the IRS Electronically?

An ALE and health coverage provider that is required to file 250 or more of the Forms 1095-B or Forms 1095-Cs during the calendar year must file the returns electronically and include the transmittal Form 1094-B or 1094-C forms with the electronic filing. An ALE or provider of health coverage that is required to file fewer than 250 of the Forms 1095-B or Forms 1095-C may file on paper or electronically.

When Must an ALE or Health Coverage Provider Furnish the Statement to the Responsible Individual?

An ALE and health coverage provider generally must furnish the statement to the employee or responsible individual on or before January 31 of the year following the calendar year in which the offer of coverage is made, or minimum essential coverage is provided.

Tax Non-Discrimination Testing

What is Nondiscrimination Testing?

To ensure that employers provide equal benefits to all employees, the tax code implemented nondiscrimination testing (NDT) requirements, which are designed to ensure that employers do not discriminate in favor of highly compensated or key employees.

Cafeteria Plan (Section 125 Plans) NDT have three basic categories:

  • Eligibility
  • Benefits
  • Utilization

The eligibility test determines whether enough non-highly compensated employees are eligible to participate in the plan. The benefits test looks at whether the same benefits are being offered to both highly compensated and non-highly compensated employees. The utilization test considers who is actually using the benefits.

This is usually the hardest of the three to pass, especially for smaller employers, because the plan will fail if a disproportionate number of highly compensated employees actually utilize the plan, regardless of the eligibility and benefits offered to all employees. Self-insured benefits (such as healthcare FSAs and HRAs) have separate NDT requirements, in addition to the cafeteria plan requirements discussed above.

When Should NDT Be Performed?

NDT must be performed by the end of the plan year. However, we generally recommend that plans perform mid-year testing to ensure that they are on-track to pass. If they discover issues midyear, they can easily adjust employee withholdings. However, if they don’t complete testing until the end of the year and fail, adjustments can be much more burdensome.

Audit Assistance

What is a Department of Labor Health and Welfare Plan Audit?

When you receive a letter from the Department of Labor (DOL) about an audit, take the letter seriously as notice that an investigation will take place, whether on a limited or full scale. As soon as possible contact your employee benefits consultant, your accountant, and someone like ASi Compliance who can assist. Do not ignore the letter or delay meeting any requests in it.  Initial DOL audit letters are document requests seeking information about the company’s health plan, documentation that proves notice requirements have been fulfilled, and information about processes and administration of the plan. They also include a usual deadline of “10 business days”. Make note of and adhere to deadlines and all requests to limit liability to potentially avoid more extensive investigative action.

What Does the DOL Look For?

The DOL looks for information and documentation regarding compliance issues. Employers should consider having a third-party administrator, such as ASi, manage their group health plans for compliance with ERISA, HIPAA, COBRA and the ACA.

What Are Penalties for Non-Compliance with Statutory Requirements?

There are several penalties imposed for noncompliance. The DOL requirements usually take the form of a $117 per day, per member penalty for noncompliance with many of the notice requirements imposed by various federal statutes. In addition, the Internal Revenue Service can impose a $156 per day, per member excise tax in addition to the DOL penalties. Other penalties include $2,194 for failure to complete Form 5500 for benefit plans with more than 100 participants, as well as, the increased likelihood that your plan will be audited in the future.

What is an IRS Letter 226J - Penalty for not Offering ACA Compliant Health Coverage?

The IRS letter 226J penalty notices are being issued to employers the agency refers to as Applicable Larger Employers (ALEs) who filed 1094/1095-C forms and who the IRS feel owes an Employer Shared Responsibility Payment (ESRP). It is part of the effort to enforce the ACA’s Employer Mandate. Under the ACA’s Employer Mandate, ALEs, organizations with 50 or more full-time employees and/or full-time equivalent employees, are required to offer Minimum Essential Coverage (MEC) to at least 95% of their full-time workforce (and their dependents) whereby such coverage meets Minimum Value (MV) and is Affordable for the employee or be subject to IRS 4980H penalties.

What is an IRS Letter 5699 -Inquiry of Non-Reporting Under ACA Mandate?

Letter 5699, which essentially states that the IRS believes that a particular organization was an ALE and failed to file ACA information returns as required by the ACA. The Letter 5699 notice asks the employer to:

(1) confirm that the employer was an ALE for the reporting year, and if so, either:

(a) confirm that the returns were already submitted, along with the   name and Employer Identification Number (EIN) used to submit the returns and date of submission,

(b) provide the returns as part of the response to the Letter 5699 or

(c) the name and EIN intended to be used when submitting the returns and the anticipated date of such submission, or

(2) deny that the employer is an ALE with an explanation. The Letter 5699 also provides for an “Other” response to explain late filings or late filings of more than 90 days to respond to the Letter 5699. Failure to timely respond to Letter 5699 may result in the penalty assessment being issued in Letter 5005-A/Form 886-A.

What is an IRS Letter 972-CG-Penaly for Non-Reporting or Late Reporting Under ACA Mandate to the Agency?

The IRS started issuing ACA penalties to ALEs that failed to file forms 1094-C and 1095-C with the IRS or furnish 1095-C forms to employees under IRC 6721/6722 using the same letter 972-CG that is used for late distribution and filing of Form W-2s and Form 1099. These notices focus on the failure to distribute 1095-C forms to employees and to file 1094-C and 1095-C forms with the federal tax agency by required deadlines, or failure to file forms electronically as required if 250 or more forms are being filed. The IRC 6721/6722 penalty assessment process is the follow-up to information employers provided to IRS on letter 5699.

Minimal Essential Coverage

What is a MEC Plan?

Minimum Essential Coverage (MEC) plans are for specific preventative services only.  Covered services are outlined by the Affordable Care Act and determined by the U.S. Preventative Services Task Force. The Affordable Care Act (ACA) requires that employers with 50 or more full-time equivalent employees provide Minimum Essential Coverage to all eligible employees.

What Does a MEC Plan Cover?

Preventive services include health care like screenings, check-ups, and patient counseling that are used to prevent illnesses, disease, and other health problems.

For a complete list of eligible services, please visit the complete list here.

What’s the Difference Between an In-Network and Out-Of-Network Provider?

When participants choose to see an in-network provider that provider accepts the payment ASi issues as payment in full for eligible services.

When participants choose to see an out-of-network provider that provider does not have to accept the payment ASi issues as payment in full for eligible services.  The provider may then bill the participant for the difference that ASi did not cover.

Health Savings Account

What is an HSA?

Health Savings Accounts accompany a High Deductible Health Plan (HDHP) and are a tax-exempt account to help your client’s employees pay for eligible healthcare expenses.

What Expenses Are Covered?

HSAs cover a variety of healthcare expenses including, but not limited to:

  • Deductibles & Co-Pays
  • Prescription Drugs
  • Dental & Orthodontic Services
  • Eyeglass, Contacts, & Eye Surgery
  • Chiropractic Services
  • Mental Health Care
  • Smoking Cessation Program

For a complete list of eligible services, please view the list of common expenses here or for a complete list visit the HSA Store.

San Francisco Health Care Security Ordinance

What is the SF HCSO?

The city of San Francisco instituted an ordinance in 2008, referred to as the San Francisco Health Care Security Ordinance (SF HCSO), which requires certain employers to provide health benefits for employees who work within the city or county of San Francisco.  Under the SF HCSO certain employers must satisfy an “employer spending requirement” by making required healthcare expenditures every quarter based on payable hours.

What Expenses Are Eligible?

Excepted Benefits HRA (EBHRA)

The following is a general listing of the eligible expenses covered under the EBHRA:

  • Dental – Expenses due to the prevention and alleviation of dental disease. Preventive treatment includes the services of a dental hygienist or dentist for such procedures as teeth cleaning, the application of sealants, and fluoride treatments to prevent tooth decay. Treatment to alleviate dental disease include services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments. Anything considered cosmetic is not a covered expense.
  • Vision – Expenses for treatment of the eye (i.e. prescription glasses, contacts, exams, office visits, etc.)
  • Long-term care benefits
  • Nursing home, Home health, Community-based care
  • Coverage limited to a specific disease or illness
Integrated HRA

The following is a general list of eligible expenses under the IHRA.  For a complete list, please visit the IRS Code Section 213(d).  To view or print the PDF of ASi’s general list of eligible expenses, please review our Integrated HRA Qualifying Expenses PDF.

  • Preventative Fees
  • Diagnostic Fees (x-rays, blood tests, lab tests, exams)
  • Prescription Fees (including insulin treatments and some OTC medications)
  • Prenatal and Postnatal Care
  • Hospital Care
  • Specialist Care (Chiropractic, Gynecology, Neurology, Podiatry, Physical Therapist, Surgeons, etc.)
  • Mental Health
  • Vision Expenses
  • Dental Expenses

What Happens If an Employee is Terminated Before Their Funds Are Fully Used?

Their HRA funds are available to them regardless of their employment status.  This HRA plan falls under an irrevocable health care expenditure and funds cannot be retained or recovered by your client, the employer.  Your client’s employees account will incur monthly or quarterly maintenance fees.