Take Control of Healthcare Costs while Avoiding a Higher Deductible
Each year, the Sound Health & Wellness Trust establishes a Health Reimbursement Arrangement – a Trust-funded medical reimbursement plan, that allows both employees and the Trust to save on healthcare costs.
Eligible plan participants can earn funding up to $500 for employee-only coverage and up to $1,000 for family coverage by annually completing a variety of health-related actions. Your HRA helps you to avoid a higher deductible as HRA funds are used to cover the first eligible medical expenses covered by the plan in each calendar year.
What Does My HRA Cover?
If you have enough funds in your HRA, the following are examples of what can be covered:
- Doctor office visits
- Lab tests
- Emergency room co-pays
- Coinsurance (SoundPlus Plan participants are eligible for in-and-out-of-network coinsurance benefits. Sound Health Plan participants only receive in-network coinsurance benefits).
Remember: Eligible in-network preventive care like wellness visits and mammograms are already covered in full, with no deductibles, coinsurance or co-pays, so your HRA will not be used for these types of services.
How Does Funding My HRA Benefit Me?
The HRA gives participants extra funds to provide first dollar coverage for the majority of their medical care expenses. This can include your doctor office visits, lab tests, or other eligible, covered medical expenses. Not until you have exhausted your HRA funds will you have to pay your deductible, which can potentially offset your costs incurred throughout the year. When you receive medical services the bill will be submitted to the Trust, then any HRA eligible expenses will go directly to your HRA for automatic payment—with no claim forms, bills or hassles for you. Also, any unused funds roll over to the next year.
You can check your HRA account online any time to track your activity, and check your balance.
How Do I Fund My HRA?
To receive full HRA funding you and your eligible spouse will be asked to complete a variety of health related actions each year. You can download the chart or view a list of approved actions below. Each year you will also be asked to complete an annual Personal Health Assessment, choose or confirm your primary care physician, and update your contact information with the Trust. If you and your eligible spouse 18 years of age or older complete all of the necessary actions each year, and are HRA eligible, you will receive HRA funding up to $500 for employee-only coverage, and up to $1000 for family coverage, and avoid a higher deductible in the
The PHA is available now. Complete your PHA, select your primary care physician and confirm your contact information from July 1 to Sept. 30, 2018 to earn part of your 2019 HRA funding.
List of Eligible Health Related Actions
All actions must be completed between Jan. 1, 2018 and Dec. 31, 2018, and you must be HRA eligible when you complete the action, for it to count towards your 2019 HRA funding.
|Earn $100 by getting a covered flu shot.|
MANAGING YOUR MEDICAL CONDITIONS
|Earn $300 by enrolling and being actively engaged in the Condition Management telephone coaching program for selected chronic conditions on Dec. 31, 2018, or graduating from the program.|
MAKING HEALTHY CHANGES
|Earn $150 by enrolling and completing three calls with your Health Coach.|
|Earn $150 or $200 by actively participating in one of the following programs: Weight Watchers®; Jenny Craig®; NutriSystem®; 3010 Weight Loss for Life®; or 2020 Lifestyles® – for three consecutive months, you can earn $150. Or, by actively participating for six consecutive months, you can earn $200. Attendance documentation is required through a form provided by the Trust. (Membership or program fees are not paid for by the Trust.)|
|Earn $150 by enrolling in Quit For Life® and completing five calls with your coach.|
You may earn a maximum of $100 for completing one of the following:
|Have an annual physical that is covered under your Prevention @ 100% benefit. (Physicals and other doctor visits performed for medical conditions are not included.)|
|Get a preventive mammogram, Pap smear or prostate exam that is covered under your Prevention @ 100% benefit. (Tests that are performed for a medical condition are not included.)|
|Have one of the following covered immunizations (as determined by the CDC recommendations): Tetanus, diphtheria, pertussis (Td/Tdap); Varicella (Chickenpox); HPV vaccine; Zoster (Shingles); Measles, mumps, rubella (MMR); Pneumococcal; Meningococcal; Hepatitis A & B.|
|Have your blood pressure, cholesterol, blood glucose & BMI (height/weight) checked by your physician or pharmacy. You will need to complete and sign a Trust provided form.|
|Get a preventive colonoscopy that is covered under your Prevention @ 100% benefit.** (Colonoscopies performed for medical conditions are not included.)|
|Earn $50, $100 or $150 by participating in Trust-sponsored LiveWell Fit events (limit four events per calendar year). You will need to complete and sign a Trust provided form.|
|If you go to the gym 20 or more times within a consecutive 3-month period, you can earn $150. If you complete another 20 or more visits within a separate additional consecutive 3-month period, earn another $50 for a total of $200. Participation documentation is required through a form provided by the Trust. Gym membership fees are not paid for by the Trust.|
|Wear your fitness or activity tracker and complete 10,000 steps per day or 5 miles of running/walking for 30 or more days within a consecutive 3-month period, you can earn $150. If you complete another 10,000 steps per day or 5 miles of running/walking for 30 or more days within a separate additional consecutive 3-month period, earn another $50 – for a total of $200. Internet-based system documentation is required through a form provided by the Trust.|
|Join the Wellness Volunteer Network and complete an orientation or annual touch base meeting with your regional Wellness Coordinator, complete two engagement activities or LiveWell Fit Empowerment Events, and complete your PHA during the annual period and earn $100.|
* To receive 2019 HRA funding you must be HRA eligible on Jan. 1, 2019. For an action or the PHA to be counted, you must be covered by the Sound Health & Wellness Trust when the health action or PHA is completed. Maximum funding to be earned is $500 for employee-only coverage or $1,000 for family coverage per year
** Subject to limitations stated in your Summary Plan Description booklet.
Do Leftover Funds Roll Over to Next Year?
Read more frequently asked questions about the HRA