The City of Lowell's Health Reimbursement Arrangement Plan (HRA) is effective October 1, 2023 and will be administered by UltraBenefits. The HRA will reimburse for eligible out of pocket expenses as outlined by the City.
Out of Pocket Expenses
The City of Lowell provides a supplemental Health Reimbursement Arrangement (HRA) plan designed to reimburse for certain out of pocket expenses. Effective October 1, 2023, the Health Reimbursement Arrangement (HRA) will be administered by UltraBenefits.
The HRA plan will continue to reimburse eligible out-of-pocket expenses as it previously has for:
Level 1: High Cost Co-payments.
Level 2: Out-of-Pocket Expenses.
Summary and overview of the Health Reimbursement Arrangement (HRA) benefits.
HRA Manual Claim Form
Use this form to submit claims manually via email, fax or mail.
HRA Attestation Form
Use this form to assist with tracking out-of-pocket expenses.
HRA Online Member Access and Explanation of Benefits (EOB)