Maximizing HRA Engagement on the Path to Consumerism

Jen Irwin, senior vice president, Marketing & Strategy at Alegeus, offers suggestions for the optimal design of HRAs.

Before we look at the role of health reimbursement arrangements (HRAs) in engagement and consumerism strategies, it’s worth taking a moment to remember why HRAs are such a powerful tool in the benefits toolbox.

The answer is simple: HRAs, which are employer-funded health plans that allow employees to receive tax-free medical reimbursements, are highly flexible, feature-rich and, when welldesigned, can drive consumer engagementall of which lead to savings for employers and their employees.

Employers like HRAs because they help offset rising costs while retaining many of the existing features in their benefit program. Companies can use HRAs to do the following, and more:

  • Protect employees from high deductibles;
  • Enter, or transition toward, a self-insured plan;
  • Lower total health and medical benefit costs without sacrificing plan richness;
  • Separate pharmacy deductibles from the medical plan; and
  • Keep co-pays in their plan design.


Unfortunately, with this flexibility comes complexity. Constructing highly customized and feature-rich plans might seem beneficial from a business perspective, but can quickly become difficult and complicated for the account holder to manage.

Keep HRAs simple

Using straightforward HRA designs with first dollar coverage allows many companies to see doubledigit cost savings in the accounts’ first year. At the same time, these employers enjoy high member satisfaction because their plans are easy to understand.

Could a company squeeze out some additional cost savings with a more complex plan? Perhaps. But even with effective communication strategies in place, many account holders will struggle to properly manage these more complex plans.

When account holders have trouble navigating their plan, reduced satisfaction and lower retention rates will inevitably follow.

Keep the account holder experience in mind

A huge dimension of good HRA plan design is account holder choice. HRAs are very much a part of the consumer-directed health care (CDH) movement, but often they are designed in a way that leaves the account holder with little insight intoor control overhow he spends his health care dollars.

For instance, oftentimes HRA plans are set up for automatic payment to the provider, which prevents the account holder from deciding how or when his medical expenses are paid. Clearly this approach is anti-consumerism, because it excludes the account holder from a major part of his health care journey.

So, what’s the solution?

HRA plans that include debit cards.

OK, OK. I’ll be the first to admit that debits cards aren’t always appropriate for HRAs. For a variety of reasons, even some simple HRA plans can render debit cards useless.

But when HRA debit cards are appropriateand that’s more often than you might thinkthey give employers an easy and valuable mechanism to increase consumer engagement in their health care finances.

Here are five of the most common ways debit cards can be included in an HRA plan:

  • HRA pays first. In this scenario, the HRA covers 100% of the account holder’s eligible medical services, up to a specific dollar amount. This allows straightforward use of the debit card until the HRA funds run out. At this point, the account holder can pay the remaining deductible and/or co-insurance out of pocket.
  • Employee cost share. Custom debit card rules can be set to allow percentage-based authorization and/or a co-pay exclusion. Stack the card with a flexible savings account (FSA), and out-of-pocket expenses can be paid automatically with the lower-priority account.
  • Upfront deductible. Once an account holder meets his deductible, the debit card can be enabled, or mailed, for future eligible medical expenses. As with the cost-share card, you can stack the card with an FSA.
  • Pharmacy only. Cards can cover pharmacy expenses, with all other reimbursements paid to the provider by the account holder or the benefits administrator.
  • Wellness incentives. Pair your HRA with a wellness incentive program that can automatically deposit earnings into an existing benefit account or a completely separate prepaid account with the option to create rules for how earnings can be used.

Successfully cross the bridge to health care consumerism

Ultimately, many employers today use HRAs as a bridge into self-insured and consumer-directed plans.

This is a move that should be applauded. After all, when they’re done well, CDH plans inspire people to make more conscious health decisions, provide employers with a strong mechanism for supporting the health of their employees, and lead to reduced costs for everybody.

But all of these benefits are dependent on good plan design. That means plans that are simple, wellcommunicated, and designed to engage account holders at every stage of their health care journey.


Jen Irwin, senior vice president, Marketing & Strategy at Alegeus

This feature is to provide general information only, does not constitute legal or tax advice, and cannot be used or substituted for legal or tax advice. Any opinions of the author do not necessarily reflect the stance of Strategic Insight or its affiliates.