Health Reimbursement Arrangement (HRA) For Small Business – Sample Document

Freedom Benefits maintains a collection of sample documents for a wide range of small business employee benefit plans. While other content is published and available in its entirety here on this web site, sample documents are available only through personal request to this site’s author Tony Novak.

The sample documents should be reviewed by an attorney before recommendation or use in any application. While we are aware that some small businesses use our sample documents as templates, we can not endorse that approach.

Following is a sample outline for a Health Reimbursement Arrangement (HRA) plan specifically designed for a small business where the employer pays the entire amount of the contribution. This design would not be used in the more common situation when the employee pays part of the health cost and the goal is to avoid paying wage taxes on health plan contributions.

Table of Contents

ARTICLE I. PURPOSE AND ESTABLISHMENT
1.1 Purpose
1.2 Name
1.3 Plan Not Subject to Cafeteria Plan
1.4 Effective Date
1.5 Termination Date
ARTICLE II. DEFINITIONS
2.1 Board of Directors
2.2 Cafeteria Plan
2.3 Code
2.4 Committee
2.5 Employer
2.6 Compensation
2.7 Dependent
2.8 Employee
2.9 Participant
2.10 Plan
2.11 Plan Adviser
2.12 Plan Year
2.13 Qualifying Medical and Health Care Expenses
2.14 Reimbursement Account
2.15 Termination
ARTICLE III. ELIGIBILITY, ENROLLMENT AND TERMINATION
3.1 Eligibility
3.2 Enrollment
3.2 Acceptance of Elections
3.3 Termination
ARTICLE IV. REVOCATION AND MODIFICATION OF ELECTED COVERAGE
4.1 Revocation and Modification
4.2 Administrative Modification
4.3 Limitations on Elections of Highly Compensated Employees
ARTICLE V. BENEFITS
5.1 Generally
5.2 Carry-Forward
5.3 Forfeiture
5.4 Benefits Not Limited to Expenses Incurred During Plan Year
5.5 Qualifying Health and Medical Care Expenses
5.6 Refund of Duplicate Reimbursement
ARTICLE VI. ADMINISTRATION
6.1 Committee
6.2 Duties and Powers of the Committee
6.3 Delegation and Allocation of Responsibilities of the Committee
ARTICLE VII. CLAIMS PROCEDURE
7.1 Submission of Claims
7.2 Review of Denial of Claims
ARTICLE VIII. FUNDING
8.1 No Obligation to Fund
8.2 No Interest
ARTICLE IX. AMENDMENTS; TERMINATION
ARTICLE X. MISCELLANEOUS
10.1 No Employment Contract
10.2 No Assignment
10.3 Choice of Law
10.4 Severability
10.5 Gender, Singular and Plural References
ARTICLE XI. ADOPTION BY MULTIPLE EMPLOYERS
11.1 Method of Adoption
11.2 Delegation Upon Adoption
11.3 Employer Contributions
11.4 Withdrawal or Removal
Appendix A – Schedule of Benefits

In addition to the plan document, a sample corporate resolution to adapt the HRA (for the employer’s records) and sample Summary Plan Description (for electronic distribution to employees) are also provided. Sample plan documents are available free of charge to the attorney of Freedom Benefits’ business clients. Plan documents are typically modified to suit your specific business intent.

Other HRA resources at www.tonynovak.com:
25 reasons that small businesses choose health reimbursement arrangements
HRA plan design approved by IRS
HRA plan helps owner/employees
HRA plan overview
HRA plans for small businesses
HRA vs. HSA: Which is best for me?
IRS approves new HRA plan design
MSAs, HRAs and HSAs: which health plan is right for my small business

(If the links are broken due to an anticipated site update then do a search for a term or phrase).

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