Claim Reimbursement

How do I claim reimbursement for a medical deductible HRA?

You receive reimbursement by submitting a completed HRA Medical Deductible Claim Form and provide a copy of an “Explanation of Benefits” (EOB) or “Benefit Summary” from the insurance company showing you have met your out-of-pocket employee deductible responsibility.

How do I claim reimbursement for a coinsurance HRA?

You must submit a completed HRA Medical Coinsurance Claim Form and provide a copy of each “Explanation of Benefits” (EOB) sheet from the insurance company showing medical charges applied to coinsurance.

When will I be reimbursed?

All faxed/mailed claims received between Monday and Friday are adjudicated as they are received, with reimbursements generated the following week.

Where do I submit my claim?

Fax (866) 320-1932
Mail: 18887 State Highway 305, Suite #600
Poulsbo, WA 98370

Explanation of Benefits

How do I find out what I have paid toward my deductible or coinsurance?

Since each insurance carrier has a different Explanation of Benefits form and lists the deductible expenses and coinsurance expenses in different places on the form, we’ve provided samples of EOBs from some of the major medical providers in Washington, Oregon and Alaska for your convenience. Click on a sample EOB below (based on your medical insurance carrier):

  • Regence Blue Shield
  • Premera Blue Cross
  • Group Health Cooperative
  • United Healthcare
  • Aetna
  • Cigna

Termination of employment

What happens if I leave the company mid-year?

For a terminated employee or any Participant who is no longer eligible under the terms of this Plan, claims will still be reimbursed but only if such reimbursement requests are made by the earlier of (1) 60 days following the date that you ceased employment or eligibility; or (2) the end of the 60-day period following the close of the Plan Year in which the expense arose. Termination of employment concurrently terminates your eligibility and participation in the plan. Any claims submitted after that time will not be considered.