The Admin America HRA Simple Plan allows an employer to purchase any high deductible fully insured health plan (HDHP) of their choice. The employer then presents to the employee a plan that mirrors the benefits of a typical lower deductible health plan. In order for the employee to receive the benefits of the lower deductible, the employer reimburses the employee for any plan eligible expenses incurred which is subject to the insured plan’s deductible but which is above the lower deductible. The purpose of the employer essentially self insuring the difference in the deductibles is for the employer to receive enough reduction in health plan premium from the insurance company to offset any amounts paid to the covered employees.

The elements of the Admin America HRA Simple Plan are:

• An Admin America HRA Simple Plan is an ERISA plan that allows tax exempt employer reimbursements for employees’ medical expenses which are not reimbursed by a fully insured health plan due to the fully insured plan’s deductibles and coinsurance provisions.

• All medical expenses are first submitted to the insurance carrier. The carrier adjudicates the claim, applies any negotiated discounts and makes the appropriate payments based on the contract. The carrier also issues the Explanation of Benefits (EOB) to the claimant.

• The claimant submits the EOB for review and reimbursement from the Simple Plan. The plan reimburses the claimant expenses above the lower deductible amount defined by the Plan but which not paid by the health insurance plan due to it’s deductible.

• HRA plans, including Simple plans are considered Health and Welfare benefit plans by the Department of Labor and are subject to ERISA’s Form 5500 requirements.