When to use this GE-HRA Reimbursement Form:
Charges submitted to your GEHA Health Care Plan are automatically processed for payment through your
HRA. However, there may be times when you will need to submit this request form manually to receive
NOTE: GEHA’s HRA allows reimbursement for services that are not covered under the
GEHA Health Savings Advantage
high-deductible health plan, but are classified as
qualified medical expenses in Internal Revenue Code Section 213(d), such as orthodontic
treatment. You must manually submit a GE-HRA reimbursement form to GEHA for
reimbursement for those types of expenses.
Expenses that have not been reimbursed under any other health plan, including coinsurance and
deductibles, are eligible expenses. Also typically eligible are physician office visits, prescriptions, dental
treatment, dentures, orthodontia, hearing devices, ambulance fees, physical therapy, oxygen, hospital
services, crutches, diagnostic tests, laboratory fees, insulin, etc. See the Plan Brochure for additional
details. Beginning January 1, 2011, over-the-counter medications are no longer considered eligible
Any expenses that have been reimbursed under any other health plan, cosmetic procedures, hair-loss
items, teeth whitening, marriage counseling, over-the-counter medications, herbs/vitamins
unless prescribed by a physician, etc. See the GEHA Plan Brochure for additional details.
Acceptable Forms of Documentation:
· Itemized statement with provider name, date and description of service, patient portion of charge(s).
Unacceptable Forms of Documentation:
· Credit/cash statements
· Cancelled checks
· Balance forward statements