Does HRA Cover Dental? What Expenses Are Eligible?
Learn whether your Health Reimbursement Arrangement covers dental expenses, what's eligible, and how to claim reimbursement.
A Health Reimbursement Arrangement (HRA) is an employer-funded plan designed to reimburse employees for qualified medical expenses. These arrangements are distinct from other health accounts because the employer owns and funds the account, with employees unable to contribute their own money. Reimbursements received by employees through an HRA are not taxable income. The specific rules governing HRAs are detailed by the Internal Revenue Service (IRS), particularly in IRS Publication 969.
HRA Coverage of Dental Expenses
Health Reimbursement Arrangements generally permit the coverage of dental expenses, provided these expenses qualify as “medical care” under IRS guidelines. While the IRS defines what constitutes a qualified medical expense, employers retain the authority to further specify which of these expenses their HRA plan will reimburse. This means that the extent of dental coverage can vary significantly from one HRA plan to another, even though the underlying IRS rules are consistent.
Employers determine the specific list of medical expenses that are eligible for reimbursement within their HRA, which is outlined in the plan’s official documents. For instance, some HRA plans might be comprehensive, covering a broad range of IRS-qualified dental services, while others may be more limited. Some employers might even offer a Limited Purpose HRA specifically for dental and vision expenses, often alongside a Health Savings Account.
Qualified Dental Expenses
The Internal Revenue Service (IRS) outlines specific criteria for what constitutes a qualified medical expense, which includes dental care. According to IRS Publication 502, dental expenses are generally reimbursable if they are incurred for the prevention or alleviation of dental disease.
Examples of typically qualified dental expenses include routine preventative care, such as teeth cleaning and examinations. Restorative procedures like fillings, crowns, root canals, and extractions also generally qualify for reimbursement. Additionally, medically necessary orthodontia, such as braces, and the cost of dentures are usually considered eligible expenses. However, procedures solely for cosmetic purposes, such as teeth whitening, are generally not eligible for HRA reimbursement unless they are medically necessary to treat a dental disease or condition.
Submitting Dental Claims for Reimbursement
When seeking reimbursement for dental expenses through an HRA, employees must adhere to specific procedural requirements. The primary step involves gathering the necessary documentation to substantiate the expense. This typically includes an itemized receipt from the dental provider, detailing the patient’s name, date of service, a clear description of the services rendered, and the amount charged.
If dental insurance is involved, an Explanation of Benefits (EOB) from the insurance carrier should also be provided, as it outlines what the insurance covered and the remaining patient responsibility. Claim submission methods generally include online portals, mobile applications, or traditional mail.
The claim form itself will require basic information, such as the patient’s name, the date the service was incurred, the type of dental service received, and the total expense. It is important to note that simple credit card receipts or statements showing only a balance due are usually insufficient for reimbursement, as they lack the required itemized detail.
After submission, employers or plan administrators typically process reimbursements within a certain timeframe, though specific timelines are defined by the individual HRA plan documents. Employees should submit claims for expenses incurred while eligible, within a specified run-out period.