Health Reimbursement Account
Non-contractual employees check with your employer to see if the HRA Plan will be offered to you.
Your HRA is a reimbursement account offered by your employer as part of your benefits package. Your employer sets up and funds the account to reimburse you for your eligible out-of-pocket health care expenses. You can use your HRA funds throughout the coverage period to pay for eligible HRA expenses.
Each plan year your employer contributes a specified amount to your HRA — you cannot make an additional contribution. You are not taxed on the value of your HRA or the reimbursements you receive from the account. Note: Expenses reimbursed under your HRA may not be used to claim any federal income tax deduction or credit.
Important: All claims must be submitted for processing within 12 months of the date of service.
Send your claim form and all supporting documentation to:
Bay Area Roofers Health & Welfare
Roofers Local 81
P.O. Box 5057
San Jose, CA 95150 Attn: Stephanie Santos
Skip the claim form and upload your receipts directly to the Wex website
- For office visits and other services— Your health plan’s Explanation of Benefits (EOB) statement or an itemized receipt or bill from the provider that includes the patient’s name, a description of the service, the original date of service and your portion of the charge.
- For prescription drugs— A pharmacy statement or receipt from your pharmacy including the patient’s name, the Rx number, the name of the drug, the date the prescription was filled, and the amount.
- For over-the-counter medicines— A written or electronic OTC prescription along with an itemized cash register receipt that includes the merchant name, name of the OTC medicine or drug, purchase date, and amount, OR a printed pharmacy statement or receipt from a pharmacy that includes the patient’s name, the Rx number, the date the prescription was filled, and the amount.
- For over-the-counter health care-related products— An itemized cash register receipt with the merchant name, the name of the item/product, date, and amount.
Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.
For some expenses, a Medical Determination Form from a doctor may be required.