Health Reimbursement Arrangement (HRA)

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.

Helpful Information

HRA Explained 

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)

UltraBenefits now has an online portal available to eligible employees wishing to access and view HRA related information. Those interested will need to create an account prior to log in.  Online Member Access Guide to creating an account and Understanding Your EOB

Claim Assistance

Employees are encouraged to contact UltraBenefits directly at 866-858-7223, ext 68107 for claim related assistance.

Employees may also contact Human Relations at 978-674-4105 for general assistance.