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Reimbursable vs. Non-Reimbursable Expenses
+ What expenses can be reimbursed by the PRA Plan?
+ What expenses are NOT eligible for reimbursement under the PRA Plan?
+ What documentation must I submit with my request for reimbursement?
What expenses can be reimbursed by the PRA Plan?
The PRA Plan reimburses eligible premium payments underwritten by Medicare or a state-licensed insurance carrier, up to your $4,000 annual allocation:
- Medicare Part B Premiums: Standard monthly Part B premiums and any applicable Income-Related Monthly Adjustment Amount (IRMAA) surcharges.
- Medicare Part D Premiums: Standalone prescription drug plan premiums and any applicable Part D IRMAA surcharges.
- Medicare Advantage (Part C) and Medigap: Monthly premiums for Medicare Advantage plans or standardized Medicare Supplement (Medigap Plans A–N) policies.
- Standalone Dental and Vision Insurance: Comprehensive individual dental and vision insurance policies underwritten and licensed by a state insurance department.
Important Note: The PRA Plan reimburses eligible health insurance premiums only (listed above). It does not cover copays, deductibles, doctor bills, prescription drug costs, discount card subscriptions, or any other expenses not listed above. You may continue using your Senior Performers HRA Plan for eligible out-of-pocket medical expenses.
Eligible expense categories remain subject to final Plan rules, administrative procedures, and applicable legal requirements. Additional guidance regarding eligible expense categories will be provided before the PRA Plan becomes operational.
What expenses are NOT eligible for reimbursement under the PRA Plan?
The PRA Plan reimburses eligible insurance premiums only. To prevent claim rejections, please note that the account cannot reimburse:
- Direct Medical Care and Office Visits: Doctor bills, copays, annual deductibles, hospital charges, coinsurance, or diagnostic lab tests. (Continue submitting eligible out-of-pocket medical expenses to your regular Senior Performers HRA Plan.)
- Retail Prescription Drug Costs: Pharmacy counter copays or out-of-pocket prescription medication costs. (Only the monthly Medicare Part D insurance premium itself is eligible.)
- Direct Dental and Vision Services: Cleanings, fillings, crowns, dentures, eye exams, eyeglasses, or contact lenses. (Only standalone individual dental and vision insurance premiums are eligible.)
- Discount Cards and Subscription Programs: Paid discount card subscriptions or fee-reduction memberships (such as GoodRx Gold, dental discount/ savings clubs, or retail optical passes). These are subscription programs, not licensed insurance policies.
- Travel Insurance: Trip cancellation policies, travel medical insurance, or medical evacuation memberships.
- Pre-Tax Premiums: Any policy premium paid with pre-tax payroll deductions through an employer’s cafeteria plan (including coverage through a working spouse) or premiums reimbursed by another plan or program.
Eligible expense categories remain subject to final Plan rules, administrative procedures, and applicable legal requirements. Additional guidance regarding eligible expense categories will be provided before the PRA Plan becomes operational.
What documentation must I submit with my request for reimbursement?
Under federal tax rules, every reimbursement must be substantiated with independent third-party documentation:
- For Medicare Part B and Part D (including IRMAA): An official Social Security Administration (SSA) Benefit Statement / COLA Notice, Form SSA-1099, or Centers for Medicare and Medicaid Services (CMS) quarterly Medicare premium bill showing the premium and surcharge amounts.
- For Private Policies (Medigap, Medicare Advantage, Dental, Vision): An official billing statement, premium invoice, or Certificate of Coverage from the insurance carrier showing the carrier name, plan type, participant name, coverage period, and monthly premium amount.