EMPOWER
Resources for HRAs
Advanced Flex Plan Administration with the Human Touch

Resources for HRAs

This page provides Employer and participant resources, forms, and guides for Health Reimbursement Arrangements (HRA).

This page shows resources to help you administer your EMPOWER HRA. If you would like to view our Enrollment Resources page that has helpful information for enrollment, click the link below.

Table of Contents

Forms

Participant Forms

Name

Description

English

Spanish

Direct Deposit Authorization Form

Add or change an existing bank account to receive reimbursements right to your bank account

HRA Claim Form

Use this form to submit an HRA claim.

QSEHRA Claim Form

Use this form to submit a QSEHRA claim.

QSEHRA Enrollment Form

Employees should use this form to provide initial attestation of minimum essential coverage.

Employer Forms

Name

Description

English

Spanish

Autopay Enrollment Form

Use this form to auto pay your EMPOWER invoices.

Banking Setup Form

Use this form to set up your Employer bank account with EMPOWER.

Nondiscrimination Questionnaire

Form for Employers to submit information for nondiscrimination testing.

Enrollment Methods

Name

Description

English

Spanish

Enrollment Spreadsheet

Use this link to download the enrollment spreadsheet to send you enrollments to EMPOWER.

EMPOWERConnect

EMPOWERConnect is an optional service that automatically integrates with your HRIS or Payroll system.

Instructional Guides

Participant Instructional Guides

Name

Description

English

Spanish

HRA Welcome Guide (Online)

Comprehensive guide to using the EMPOWER FSA.

Coming Soon

HRA Plan Fact Sheet

A single page handout that contains specific details about your Plan.

Your Account Manager will email this to the Employer before open enrollment starts. Participants also have access to this document on their portal.

Participant Portal Quick Start Guide

Learn how to use the Online Portal.

Coming Soon

QSEHRA Welcome Guide

PDF Guide that explains the QSEHRA for participants.

Coming Soon

Employer Instructional Guides

Name

Description

English

Spanish

Employer Welcome Guides

Guides are available that explain how to administer your EMPOWER Plan.

You will receive guides when setting up a new plan and during open-enrollment. Ask your Account Administrator for additional information.

Employer Portal Quick Start Guide

Use this guide to learn how to use the Employer Online Portal.

PCORI Guide

Read this guide to determine if you are required to pay PCORI fees to the IRS.

EMPOWER Participant
Mobile App Download

If you have an FSA, HRA, or HSA with EMPOWER, we encourage you to
download the Mobile App to manage your benefits on the go!
Apple iOS
Google Android

EMPOWER LOGIN

I am a Participant
Click the above link if you are a participant who has an FSA, HSA, or HRA with EMPOWER.
I am an Employer
Click the above link if you are an Employer or Consultant.

Download Forms

Click one of the links below to view the available forms.

I am a Participant
Click the above link if you are a participant who has an FSA, HSA, or HRA with EMPOWER.
I am an Employer
Click the above link if you are an Employer or Consultant.