This health reimbursement arrangement plan (hra) template has 7 pages and is a MS Word file type listed under our human resources documents.
Sample of our health reimbursement arrangement plan (hra) template:
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) PLAN While there is no requirement that you use a third party administrator, it is important that your Health Reimbursement Arrangement complies with all IRS, DOL, and ERISA guidelines. For this reason, most tax professionals encourage their clients to use a company that specializes in this type of employee benefit plan. This Health Reimbursement Arrangement (HRA) Plan (the "Plan") is made and effective [DATE], BETWEEN: [YOUR COMPANY NAME] (the "Company"), a corporation organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at: [YOUR COMPLETE ADDRESS] AND: [EMPLOYEE NAME] (the "Employee"), an individual having his/her main residence located at: [COMPLETE ADDRESS] RECITALS Whereas, [YOUR COMPANY NAME] desires to provide medical care benefits relating to expenses not covered under a medical policy; Resolved, Health Reimbursement accounts shall be maintained for each full-time employee from which covered expenses (as defined in Section 213 of the Internal Revenue Code) for the employee or their dependents shall be reimbursed. [YOUR COMPANY NAME]-funded reimbursements to an employee shall not exceed [AMOUNT] during one calendar year. [YOUR COMPANY NAME]-funded reimbursements to an employee with dependents shall not exceed [AMOUNT] during one calendar year. Resolved, the submission of medical expenses must be in a form and in sufficient detail to meet the requirements of the [YOUR COMPANY NAME]. Expenses may be submitted until [DATE] for the previous calendar year. Resolved, the Plan shall be administered in a nondiscriminatory manner (as defined in Section 150(h) of the Internal Revenue Code) and shall remain in effect until modified or terminated by a later resolution. Resolved, the plan shall reimburse former employees for medical care expenses up to an amount equal to the unused reimbursement amount remaining at retirement or other termination of employment. NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, the parties hereto, intending, to be legally bound, agree as follows: Purpose Effective as of [date plan goes into effect], [YOUR COMPANY NAME] establishes a Health Reimbursement Arrangement Plan effective [DATE] for the benefit of all full-time employees (working at least [NUMBER] hours or more per week) and their dependents (employee's spouse and minor children) under Section 105(b), (e) of the Internal Revenue Code as from time to time amended. The provisions of the Plan, as set forth herein, shall only apply to an eligible employee who is in the active employ of the Employer on or after [date of eligibility]. Definitions and Construction Definitions Where the following words and phrases appear in this Plan, they shall have the respective meanings set forth in this Article, unless the context clearly indicates to the contrary. Principal Entities Plan: The HRA Plan for Employees working for [YOUR COMPANY NAME], the Plan set forth herein, as amended from time to time. Employer: [YOUR COMPANY NAME], a [legal status (i.e., a corporation)] organized and existing under the laws of the State of [name of state], or its successor or successors. Committee: The person or persons appointed pursuant to Section 6 to assist the Employer with Plan Administration in accordance with said Section. Employee: Any person who, on or after the Effective Date, is receiving remuneration for personal services rendered to the Employer. Participant: An Employee participating in the Plan in accordance with the provisions of Section 3.1. Fiduciaries: The Employer and the Committee, but only with respect to the specific responsibilities of each for Plan administration, all as described in Section 6.1. 2.3 Determination of Contribution and Other Definitions Participation: The period or periods during which an Employee participates in this Plan as determined in accordance with Section 3.1. Compensation: The total of all amounts paid to a Participant for a given Year by the Employer for personal services and reported as wages for purposes of income tax, or substitute, less (1) amounts paid while covered by a collective bargaining agreement which does not provide for inclusion hereunder, (2) the cost of providing group term life insurance in excess of the statutory amount, (3) reimbursed moving expenses, (4) any other amount required to be reported which is not direct compensation for services performed and (5) amounts in excess of [AMOUNT]. Effective Date: [The effective date], the date on which the provisions of this Plan became effective. Year: The 12-month period commencing on January 1 and ending on December 31. Code: The Internal Revenue Code and any other Codes relating to issues contained in this Plan, as amended from time to time. 2.4 Construction The masculine gender, where appearing in the Plan, shall be deemed to include the feminine gender, unless the context clearly indicates to the contrary. The words "hereof," "herein," "hereunder" and other similar compounds of the word "here" shall mean and refer to the entire Plan and not to any particular provision, Section or Article. Article and Section headings are for convenience of reference and not intended to add to or subtract from the terms of this Plan. Participation and Notifications Participation Except for an Employee who, for the entire Year was covered by a collective bargaining agreement which does not provide for his inclusion hereunder, an Employee shall participate in the Plan for any Year in which he meets the following requirements: He/she has performed services for the Employer at some time during the Year His/her Compensation for the Year is [AMOUNT] or greater, and the given Year is preceded by a [NUMBER]-year period that includes at least three Years in each of which he/she has performed services for the Employer at some time during the Year Notifications [YOUR COMPANY NAME] shall notify an Employee in writing when he first becomes a Participant. Such notification shall include information required to be furnished by [GOVERNMENT AGENCY]. Such notification shall also advise the Participant that he should establish a Health Reimbursement Arrangement and the date by which the establishment should be accomplished. If the Participant fails to notify the Committee of the establishment of a HRA as of the prescribed date, the Committee shall choose a Health Reimbursement Arrangement Plan for such Participant and execute such forms and documents as may be necessary to establish a Health Reimbursement Arrangement Plan for and on behalf of such Participant. Contributions NOTE: The following Section 4.1 incorporates the requirements of [CODE] regarding the permitted disparity in plan contributions. The contribution percentage for compensation above a certain level cannot exceed the contribution percentage on compensation below a certain level by more than the lesser of: the contribution percentage on compensation below a certain level, or the greater of: [%], or the percentage equal to the portion of the rate under Internal Revenue Code Employer Contributions On and After [DATE] Each Year the Employer shall determine whether or not a contribution will be made under the Plan for that Year. If the Employer determines that a contribution will be made for a Year, then, subject to the provisions of Section 4.4, the contribution made on behalf of each Employee who is a Participant for that Year shall be equal to: a percentage of Compensation, as determined by the Employer, payable to all Participants; to the extent any contribution has not been allocated under (a) above, an additional allocation shall be made to all Participants considering only their compensation in excess of the social security wage base for the Year. The percentage for any additional allocation under this Section 4
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