This Week’s Focus
Week 1: Keep the Plan. Fix the Flaw.
The simplest, most overlooked opportunity: Using a Limited-Line HRA to plug one specific gap in a health plan.
Common Gaps This Can Fix
- Tier 3 or specialty prescriptions that are unaffordable
- Need for just a few more mental health sessions
- Coverage for GLP-1s, infertility, or travel for care
- One copay or coinsurance amount causing pain
Why This Works
- No need to replace the whole health plan
- No need for a broader MERP/HRA or multi-benefit program
- Just a targeted, affordable fix
What Is a Limited-Line HRA?
Covers a specific gap in a health plan without the cost or complexity of a full MERP
Tax-free, compliant, and easy to administer
Reimburses employees for one or two defined categories of care
Works alongside any group medical plan (including ACA-compliant and fully insured)
Keeps the benefit experience strong without disrupting the rest of the plan design
Cost & Administration
Monthly Cost:
$5 per employee, per month for narrowly defined benefit categories
Pricing applies to single-benefit or limited-scope designs; broader programs are custom quoted
Included Services:
- Claims processing
- Dedicated customer service
- Spanish-language support
Examples: Gap → HRA Fix
Mental health visit caps
Reimburses sessions after carrier’s limit is reached
Tier 3 or specialty prescriptions
Covers high-cost meds not fully paid by plan
GLP-1s & weight management Rx
Targets excluded or capped drug categories
Infertility / family-building benefits
Offers flat-dollar support for uncovered services
Out-of-network / second opinions
Covers consults when a specialist is out of network
Travel for care
Reimburses mileage, lodging, or meals for out-of-area treatment
One-off high copay (e.g., specialist)
Helps cover a specific service with consistent cost share
How to Pitch It
Listen for client comments like:
- “We love our plan, but…”
- “We just wish it covered…”
- “Our employees keep asking about one specific thing…”
Present the limited-line HRA as:
- Affordable
- Fast to implement
- Flexible
Bottom Line
Sometimes the best move isn’t a big change — it’s a small, smart one.Let’s fix the flaw.
