Advanced Flex Plan Administration with the Human Touch
Spousal Incentive HRA
The Spousal Incentive HRA (SpHRA) works like a Traditional Health Reimbursement Arrangement, but provides reimbursement for only those employees who are enrolled in their spouse’s plan. The SpHRA is a great way to incentivize employees to enroll in their spouse’s plans instead of their Employer’s plan.
Employers who offer a Group Health Plan may offer a SpHRA
Employees are eligible if they decline coverage and provide proof to their Employer of enrollment in their spouse’s plan.
Who Can Contribute
Only the Employer can contribute to an SpHRA.
A SpHRA can be used with a Spousal Surcharge to further incentivize employees to join their spouse’s plan.
Advantages of a SpHRA
- The Employer saves by reducing the number of members covered in the GHP.
- Employees receive HRA funds to assist with medical expenses under the spouse’s policy.
How it Works
The Employer hosts Open Enrollment with employees. To enroll in the SpHRA, Employees may provide proof of enrollment in their spouse’s plan to the Employer.
HRA funds are available to employees on the first day of the Plan Year based, depending how the SpHRA is structured.
EMPOWER administers the Plan and issues reimbursements to employees after claims are filed. SpHRA reimbursements are made from an Employer-owned account.
Employees who enroll in their spouse’s plan must submit proof to their Employer to enroll in the SpHRA.
Participants use their spouse’s insurance or pay out of pocket for eligible expenses.
Participants file claims to EMPOWER with the insurer’s Explanation of Benefits (EOB). EMPOWER reimburses claims conveniently from the Employer’s bank account.
EMPOWER Can Tailor a SpHRA to Meet Your Needs
Employers can customize their plans with many options, including:
- Choose the deductible amount (employee out of
pocket before SpHRA pays) for single and family coverage.
- Choose whether the SpHRA pays out to an individual who has met the single deductible prior to the family reaching their deductible.
Choose whether the SpHRA pays at 100% or a different amount after the deductible is met.
Choose how the SpHRA handles copayments.
Want the Latest Contribution Limits and Guidelines?
EMPOWER’s Benefits Solutions Guide takes the guesswork out of benefits by providing a comprehensive synopsis of each plan type, as well as comparisons and sample scenarios.