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Online HRA Plan Document Order Form:

First, choose one HRA Plan from the following four options:

Comprehensive Plan - $299 one-time setup fee

The Comprehensive HRA can cover any out-of-pocket medical expense that include but are not limited to dental expenses, vision expenses, co-pays, deductibles, medical expenses and health insurance premiums. The Comprehensive Plan may or may not be coupled with a high deductible health coverage or limited-benefit medical plan.

Limited - $299 one-time setup fee

A Limited HRA will cover only specified out-of-pocket medical expenses such as prescriptions, dental, vision etc. and can be restricted to cover just one medical expense.

Premium Reimbursement Arrangement (PRA) Plan - $299 one-time setup fee

The PRA allows employers to reimburse only health insurance premiums including group sponsored insurance plans as well as individual health insurance policies outside the group, or long-term care insurance.

Deductible Gap - $299 one-time setup fee

The Deductible Gap HRA is designed to be coupled with a High Deductible Health Plan and will pay for only items covered by the insurance policy it compliments. The employer benefits from reduced insurance costs, but the effect to the employee is cushioned with the Deductible Gap HRA.

A Document Consultant will contact you with questions and additional design options once we receive your basic information. Click the "Next" button below to continue to the next screen.

IMPORTANT: Many small employers take insurance premium and medical expense reimbursement deductions without the knowledge that a formal Plan Document and Summary Plan Description are required by the Internal Revenue Code. Many CPAs, bookkeepers, and accountants are unaware of this requirement. The penalty for non-compliance may include disallowance of all deductions, payment of all delinquent taxes plus interest and penalties.

[Phone] 1-888-755-3373 [Email]

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