Page 6 - Fort Health Care 2022 Benefit Guide

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HEALTH REIMBURSEMENT ARRANGEMENT (HRA)

A health reimbursement arrangement (HRA), sometimes called a health reimbursement account that is paid solely by Fort
HealthCare. This account will reimburse only qualified medical care expenses eligible for coverage under your medical
benefit plan.
Unused portions of your HRA may be carried forward into subsequent Plan Years as detailed in the Summary Plan
Documents (SPD). You may obtain a copy of the SPD on the Fort HealthCare’s intranet, on your UMR account portal, or
by contacting Human Resources at (920) 568-5143 to request a copy.

Your medical benefit plan and your HRA are considered a single benefit plan. HRA enrollment is based on fulfillment of
the annual Wellness Plan requirements. You are not eligible to participate in the HRA without participating in the FHC
medical benefit plan.

• Benefit plan owned and funded by FHC. *NEW HRA CONTRIBUTIONS FOR 2022
• Applies to participants in the FHC Group Health Plan ONLY.
• HRA managed by UMR Points Single Single +1 Family
(markers) Coverage Coverage Coverage
• HRA funding based on Wellness Plan outcomes-based program points Earned
(markers) listed to the right. 0 $0 $0 $0
• The effective date of coverage under the Health Reimbursement 1 $350 $700 $1,050
Arrangement (HRA) for you and your dependents coincides with the 2 $450 $900 $1,350
effective date of coverage under the Medical Benefit Plan. 3 $550 $1,100 $1,650
• HRA dollars are applied towards the annual deductible – 4 $650 $1,300 $1,950
automatically through UMR when claims are processed.

COST OF YOUR BENEFITS

Fort HealthCare pays the full cost of many of your benefits; you share the cost for others. Listed below are the benefits offered, how
they are taxed, and who covers the cost. You pay the full cost of any voluntary benefits you elect.

Benefit Tax Treatment Who Pays
Medical Coverage Pretax Fort HealthCare & You
Dental Coverage Pretax Fort HealthCare & You
Vision Coverage Pretax You
Basic Life and Accidental Death & Dismemberment (AD&D) After-tax Fort HealthCare
Additional Life and Accidental Death & Dismemberment (AD&D) After-tax You
Disability Coverage After-tax Fort HealthCare
Flexible Spending Accounts Pretax You
401(k) Retirement Savings Plan Pretax Fort HealthCare & You

Guide to Your Benefits | May 1, 2022 – April 30, 2023