HRA Forms & Documents

BELOW ARE SAMPLE FORMS WITH EXPLANATIONS FOR THEIR USE AND A LINK FOR DOWNLOADS

 

HRA Introduction

 

This brochure highlights the advantages

available for employers offering a Health Reimbursement

Arrangement, commonly called a Health Reimbursement Account.

 

Download this brochure with this link. 

 

 


 

HRA Employer FAQ

 

Questions and Answers for Employers

contemplating the decision to offer a Health

Reimbursement Arrangement, or HRA.

 

Download this brochure with this link.

 

 


 

HRA Reimbursement Request Form

 

Use this form to submit reimbursements for qualified Healthcare

expenses when you did not or could not

 use the Alliance Flex Card.

 

Download this form with this link.

 

 


 

 

HRA Direct Deposit Form

 

Use this form to direct Alliance Insurance Group to direct deposit
your reimbursements from manual (non-Flex Card) transactions

directly with your bank. This form is typically used in conjunction

with the Reimbursement Form above.

 

Download this form with this link.