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Contents: Enrollment Provisions and Coverage Period Forms: Direct Deposit Authorization/ TSB-HRA Claim Form (PDF) See also: IU HRA Plan Booklet IU HRA Plan 2008 Summary Eligible/Ineligible TSB Expenses (PDF) Covered and non-covered over-the-counter items (PDF)
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IU Wellness Health Reimbursement Arrangement (HRA) Plan Important Note about 2007-08 Enrollment: In order to receive Wellness HRA Plan contributions in 2008, you must have completed Section 7 of the Open Enrollment 2008 form to sign the Tobacco-free Wellness HRA Plan Affidavit. If you did not complete Section 7, you have not be enrolled in the Tobacco-Free Wellness Program; you will not receive Wellness HRA contributions during 2008; and your opportunity to participate will not be until the next Open Enrollment (November 2008 with an effective date of January 1, 2009).
All full-time appointed employees of Indiana University can elect participation in the Wellness HRA Plan. The Wellness HRA is an employer-paid account set up under Internal Revenue Service regulations that allow preferential tax treatment for contributions. The account is funded entirely by the university. Neither IU contributions to nor reimbursements from an HRA are considered taxable income to the employee. To participate in the Wellness HRA Plan, employees must sign an affidavit each year during Open Enrollment indicating that they do not use tobacco products and will not during the upcoming year. For each employee who enrolls, the university will contribute $10 a month to an HRA account set up in her or his name. Employees who are not tobacco-free at the time of Open Enrollment may still enroll in the Wellness HRA by agreeing to the following:
IU contributions will be discontinued at any time an employee has failed to honor the affidavit. Tobacco includes any form of tobacco products that are smoked (e.g., cigarettes, cigars, pipes), applied to the gums (dipping and chewing tobacco), and/or inhaled, as snuff. Reimbursements from the Wellness HRA will be allowed for IRS-approved medical expenses incurred by the employee, such as deductibles, copays, non-covered medical expenses, and over-the-counter medications.
The Wellness HRA Plan is funded entirely by Indiana University. Enrollment Provisions and Coverage Period The HRA Plan is offered on a tax year basis, and elections for participation in reimbursement accounts expire automatically at the end of each calendar year. Employees must enroll in the Wellness HRA Plan each November during Open Enrollment to be eligible for benefits the following year. Employees will not be enrolled in reimbursement accounts without taking specific action for enrollment each year. Continuing employees must enroll each year during the Open Enrollment period in November for participation the following year in a reimbursement account. Unused year-end account balances up to a $240 maximum will carry over into the next year. Terminating employees—and employees whose participation in the plan ends due to transferring to an ineligible position—will be able to use their balance through the end of the calendar year in which they terminate or transfer. Employees who are part of a reduction in force will have additional time to use their balance. Claims will only be paid from the HRA account for the amount of contributions accumulated at the time of the claim. Claims can be submitted online, by fax, or by mail to Nyhart. Claims for reimbursement may be filed at any time during the Plan year (January 1 through December 31). Claims will only be honored for services rendered during the Plan year. For Employees Enrolled in both the Wellness HRA and TSB Plans, Nyhart will reimburse claims using Tax Saver Benefit (TSB) funds first since they do not roll over. Employees will be able to view their HRA and TSB accounts side by side on the Nyhart Web site. The TSB-HRA card may be used for HRA claims as well as TSB plan claims. If you have questions about allowable expenses or making a claim, contact The Nyhart Company Claim Center at 800-284-8412. Customer Service Contacts:The Nyhart CompanyFor questions concerning qualified expenses, claims and reimbursement account balances: To mail or fax claims:
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