Health Reimbursement Arrangement (HRA)

DEADLINE to submit all documents to the Fund Office:  FEBRUARY 14, 2015


2014 HRA Reimbursement Request Form

Effective December 31, 2013, the Jefferson Parish School Board (“School Board”) discontinued all contributions to the Jefferson Federation of Teachers Health & Welfare Fund (“Fund”).  Beginning January 1, 2014, the School Board is offering dental, vision, life insurance and FSA benefits to all eligible employees.

There are assets remaining in the Fund, which the Board of Trustees of the Fund have decided to use to continue to provide eligible employees with a $10,000 life insurance benefit (this is in addition to the life insurance benefits provided through the School Board), and a new $350 per employee Health Reimbursement Account through December 31, 2014, subject to the rules described below.



Effective January 1, 2014, a new “Health Reimbursement Arrangement” became available to those participants who were employed by the School Board and participating in the Plan on December 31, 2013. A Health Reimbursement Arrangement, or HRA, is a health care reimbursement account that allows you to obtain reimbursement of covered medical expenses on a tax-free basis. The Plan will set up an HRA account for each covered employee in order to track allocations and available reimbursement amounts.


You are eligible to participate in the HRA if you were employed by the Jefferson Parish School Board and covered for benefits through the Fund on December 31, 2013, and will continue to be covered for the benefits offered through the Fund as long as you are employed by the Jefferson Parish School Board.  Newly hired employees who were not yet eligible for benefits from the Fund as of December 31, 2013 are not eligible for benefits provided through the Fund.

Contributions to your HRA Account

Contributions to your HRA account consist of trust assets derived from employer contributions that were made in accordance with a collective bargaining agreement, letter agreement or participation agreement, plus interest earnings. No employee contributions or other contributions are allowed.

If you are eligible to participate in the HRA, $350 will be credited to your account for the initial Plan Year. The Board of Trustees, in its sole discretion, will determine the amount of contributions, if any, in subsequent Plan Years.

HRA Reimbursable Expenses

You may use your HRA account to obtain reimbursement of “HRA Reimbursable Expenses” incurred by you on or after the date you first become eligible to participate in the HRA. HRA Reimbursable Expenses are limited to the following expenses incurred, by you, the employee, only.

  • Any deductibles, copayments or coinsurance you are required to pay in connection with benefits received through any group health plan for any eligible medical or prescription drug expense,  excluding dental or vision expenses.
  • To be reimbursable under the HRA, a claim for the HRA Reimbursable Expenses must first be submitted for payment through the group health plan under which you are covered. An Explanation of Benefits (EOB) form must be obtained from your group health plan or a receipt for prescription drugs must be obtained from your pharmacy. Only those expenses that are covered, but not reimbursed, will be considered HRA Reimbursable Expenses.

The following expenses are not eligible for reimbursement from your HRA account:

  • Unless otherwise specified, no other expenses will be covered regardless of whether they are included in the list of  covered items found in the Internal Revenue Code;
  • HRA Reimbursable Expenses that have been reimbursed or are reimbursable from another source, including any other medical plan, HRA or Flexible Spending Account (FSA);
  • Reimbursable expenses for which you fail to submit a claim containing all required information or within the time period specified in the Plan;
  • Except for the final reimbursement claim for the Plan Year or when coverage is fully terminated, reimbursable expenses for which you submit a claim that totals less than $50;
  • COBRA premiums or premiums for other insurance coverage;
  • Dental or vision expenses; and
  • Expenses incurred for a dependent or spouse.

Submitting a Claim for Reimbursement

To be reimbursable under the HRA, a claim for the HRA Reimbursable Expenses must first be submitted for payment to the group health plan under which you are covered.  An explanation of benefits (EOB) form must be obtained from the health plan. Only those expenses that are covered, but not reimbursed, as shown on the EOB form, will be considered eligible HRA Reimbursable Expenses. For prescription charges, you must submit a receipt from the pharmacy that contains the following information:

  • The name of the pharmacy;
  • The name of the group health plan;
  • The name of the employee;
  • The date of the prescription was dispensed; and
  • The employee cost share for the drug.

In order to be reimbursed from your HRA account, you must submit a completed HRA claim form to the Fund Office within forty-five (45) days immediately following the end of the Plan Year in which the expense was incurred. To obtain an HRA claim form, please contact the Fund Office.

All claims for reimbursement must include the following information:

  • The name of the employee.
  • The nature and date of the expense incurred.
  • The reimbursement amount requested.
  • A statement that the expense has not otherwise been reimbursed and is not reimbursable through any other source.

Reimbursement by the Fund

Within 30 days after the Fund Office receives your claim for reimbursement, you will be reimbursed if your claim is approved, or notified in writing if your claim is denied.  Reimbursement will be made only up to the unused amount credited to your HRA account.  The 30-day time period may be extended for 15 days for matters beyond the control of the Fund Office, including cases where a reimbursement claim is incomplete.  If extended, written notice of the extension and reasons why it is needed will be provided to you within the first 30 days after receipt of the claim. If a claim is incomplete, you will be given 45 days to submit the required information.

If your claim is denied, you may appeal the determination and receive a full and fair review in accordance with the Plan’s claims and appeals procedures.

Opt Out and Waiver

You will have the right to permanently opt out of participation in the HRA and to waive future allocations to or reimbursements from the HRA as described in this Notice. This right may be exercised at any time by written notice to the Fund Office before the intended effective date of the permanent opt out and waiver, as specified in the notice. Upon your effective opt-out and waiver, you shall no longer be eligible to participate in the HRA or to receive allocations to or reimbursements from an HRA account, and any existing HRA account balance shall be forfeited, without the right to future reinstatement of the HRA account or of participation in the HRA.

Termination of Eligibility

Your participation in the HRA will terminate on the earliest of the following dates to occur, subject to your right (if any) to continue coverage under COBRA:

  • The date you no longer satisfy the requirements for eligibility to participate in the HRA.
  • The date on which the HRA is terminated in accordance with the termination provisions of the Plan.
  • The date on which you opt out of participation in the HRA.

Reimbursements after Termination

When your participation in the HRA terminates, you may claim reimbursement from your remaining HRA account balance (if any), for expenses incurred by you within 45 days immediately following termination. If your participation terminates by reason of your death, or if you should die within 45 days immediately following termination of your participation, your dependent(s) or your estate may claim reimbursement from your remaining HRA account balance (if any) for expenses incurred by you prior to your death during the 45-day period immediately following your death.

Forfeiture of Account Balances

If any balance remains credited to your HRA account at the end of a Plan Year, it will not be carried over in the following year. Any remaining balance credited to your HRA account will be forfeited and will no longer be carried over for reimbursement in a subsequent Plan Year.

Further, if at any time you opt out of participation of the HRA, your account will be forfeited.

Once the balance of your HRA account is forfeited, it will not be reinstated.

Tax Consequences

The Fund does not guarantee that amounts reimbursed under your HRA account will be excludable from your gross income for income tax purposes. You must determine whether HRA payments are excludable, and notify the Fund Office if you believe a payment is not excludable. If you receive reimbursement under the HRA on a tax-free basis and the payment does not qualify for tax-free treatment under the Internal Revenue Code, you will be required to reimburse the Fund for any liability it incurs for failure to withhold taxes.


The Board of Trustees reserves the right to amend or terminate the HRA at any time and for any reason. You do not have a vested right to your HRA account or the contributions credited to it.

The Board of Trustees will continue to monitor the available assets to determine if any benefits can be extended beyond 2014.  We’ll keep you updated on any changes.  Once the assets of the Trust have been distributed, the Fund will be terminated.

For more information, contact the Plan’s Administrative Manager at the following address or telephone number:

Ms. Mickey Graham

2540 Severn Avenue, Suite 302

Metairie, Louisiana 70002

Telephone number:  504-455-7261

Full details of these changes will be set forth in the documents that establish the Plan provisions.  If there is a discrepancy between the wording in this Notice and the Plan document, the Plan document language will govern. The Trustees reserve the right to amend, modify, or terminate the Plan at any time.


Your receipt of this Notice is not a certification that you are eligible to receive any benefits under the Plan. You must satisfy the Plan’s eligibility requirements to receive benefits.