Paying for care
1. Visit your doctor, show your ID card —you may have a copay(Out of network, you may need to pay the full amount.)
2. Doctor files your claim
(Out of network, you file your own claims.)
3. Plan pays the doctor any amount it owes based on the negotiated rate
(Out of network, the plan pays you back what it owes, up to the “reasonable and customary” limit.)
4. Doctor bills you for any amount you owe
HRA vs. HSA vs. FSA
You may be offered one or more of the tax-free accounts* below to help pay medical costs not covered by your plan.
Qualified expenses include:
- Copays, coinsurance and deductibles
- Dental expenses such as orthodontia, crowns and bridges
- Vision expenses like LASIK eye surgery, glasses and contacts
- Prescription drugs and over-the-counter (OTC) items**
*Check your plan details for the maximum amount you may contribute. Please also confirm with your employer, as limits are subject to change.
**You'll need a written prescription for OTC drugs and medicine.
Specific plans may vary, but here are the main differences between these accounts:
|Health reimbursement arrangement (HRA)||Health savings account (HSA)||Flexible spending account (FSA)|
|An HRA is a company-funded account that covers the first 50% of your deductible and automatically pays covered costs first when you receive care or prescription drugs.||An HSA is a company-funded account you can contribute pretax dollars to. Company contributions are not funded up front but throughout the plan year.||FSAs let you pay for certain eligible health and dependent care expenses with pretax dollars.|
|Usually pairs with a high-deductible health plan.||Requires a high-deductible health plan.||Pairs with most types of health plans, but a health plan is not required.|
|Only eligible employers can contribute.||You, your employer or anyone else can contribute.||You and your employer can contribute.|
|If you don’t use all of the HRA funds, the remaining balance is carried over to the new plan year if you stay enrolled in the shared deductible plan.||If you don’t use all your money in the HSA during the plan year, the remaining amount stays in your account even if you change your plans, retire or leave the company.
||If you don’t use the money in your FSA account(s) by the deadline, the unused FSA money is forfeited in accordance with the IRS rule known as the “use it or lose it” rule.|