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
QSEHRA Enrollment Form
Employees should use this form to provide initial attestation of minimum essential coverage.
Employer Forms
Name
Description
English
Spanish
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.
