Last updated date: June 13, 2024

Collective Health provides the Medical HRA designed to support employees with medical expenses that covers a variety of eligible products and services, listed below. This document outlines the program policy.

Who is Eligible?

All U.S. full-time employees who are enrolled in Collective Health’s Core Group Medical Plans are eligible to participate in the program. Employees not enrolled in the Core Collective Health medical plan cannot enroll in the Collective Health HRA and neither can their spouse or domestic partner. You must be employed by Collective Health when eligible expenses are incurred (paid for).

Program Administration

Forma is the administrator for the HRA program. For general FAQs, please refer to the help center. You can reach Forma’s Customer Support Team by emailing support.joinforma.com or through the live-chat feature directly in your Forma account.

Benefit Amount

Eligible employees will receive either $375 (Individual coverage) or $750 (Family coverage) per calendar year for eligible products and services listed below based on their Group medical coverage tier. Any unused amount expires at the end of the calendar year. There is a 90 -day run-out period for expenses incurred in the previous plan year.

How the Program Works

The funds will be deposited into your Forma Account on the 1st of each year. You may spend the allowance using Reimbursement Claims.

Eligible dependents who are enrolled in the Core Medical Plans can also have their claims submitted for reimbursement.

• Dependent means a spouse (or domestic partner who qualifies as a dependent as defined by the Employer) and is enrolled in the Employer's group medical plan.

💵 Reimbursement Claims

If you pay out of pocket for an eligible expense incurred by either you or an enrolled dependent, you may submit a reimbursement claim through the Forma portal. (A list of eligible categories and examples can be found in the next section.) Reimbursement requests will be processed within 2-3 days. Please submit the following items when filing your reimbursement claim:

1. Receipt with your name, item name, purchase date, and purchase amount

If your request for reimbursement is approved, the amount of your reimbursement will be paid to you via direct deposit from Forma. The reimbursements will arrive in your bank account within 4-5 business days after the claim has been approved.

Expenses must be incurred on or after January 1, 2023 to be eligible for reimbursement through Forma.

The Forma claims review team will review the receipt by checking - (1) Claimant name (2) Service date (3) Item name (review based on the eligibility list listed below) (4) Amount (5) Provider name