How Are Reimbursement Requests Submitted and Approved?

Understanding the reimbursement request submission and approval process is essential for both employers and employees to make the most of their health benefits. When your company offers a benefit like an Individual Coverage Health Reimbursement Arrangement (ICHRA), knowing how to correctly submit claims ensures you get your money back quickly and without any hassle. This guide breaks down the entire workflow, from gathering your documents to seeing the funds returned to your account.

Overview of the Reimbursement Process

At its core, a reimbursement is a repayment for an expense you have already paid out-of-pocket. In the context of health benefits, this means you pay for a qualifying medical expense or insurance premium first, and then your employer pays you back with tax-free dollars through a plan like ICHRA. This approach is fundamental to modern, flexible benefits because it gives employees the freedom to choose the health plans and services that best fit their needs.

The process involves a few key stakeholders:

• The employee: The individual who has incurred a medical expense and is seeking repayment.
• The employer: The company that funds the reimbursement arrangement to provide a valuable health benefit to its team.
• The administrator: A third-party administrator (TPA) or a platform (such as  Venteur) that manages the process. TPAs verify expenses, ensure compliance, and facilitate payments, simplifying the experience for everyone involved.

Steps to Submit a Reimbursement Request

The journey from paying for a medical expense to getting reimbursed is straightforward when you follow a clear set of steps. The ICHRA reimbursement submission process is designed to be efficient, but success depends on careful preparation and accurate submissions.

Preparing Necessary Documentation

Before you can submit a request, you need to gather proof of your expense. This is the most important step, as your reimbursement cannot be processed without it. This means keeping detailed records of your health insurance premiums and any other qualified medical costs. You should have digital or physical copies of receipts, invoices, and statements ready before you begin the submission process.

Filling Out the Reimbursement Request Form

Once you have your documents, the next step is to formally request the reimbursement. This is typically done by filling out a claim form. Most modern benefits platforms provide a simple online form that guides you through the process, asking for key details like the date of service, the type of expense, and the amount. It's crucial to fill out this information accurately to avoid delays.

Common Submission Methods

How you submit your request often depends on the system your employer uses. Common methods include:

• Online Portals: The most common and efficient method. Platforms like Venteur offer a user-friendly dashboard where you can upload documents and fill out a claim form in minutes. This is the preferred method because it provides a clear record of your submission and allows for easy tracking.
• Mobile Apps: Many platforms also offer mobile apps, allowing you to submit a claim by simply snapping a photo of your receipt right after you’ve made a payment.
• Email or Physical Forms: Some companies may still use traditional methods where you email your documents to an administrator or submit physical paperwork. While functional, these methods can be slower and more prone to errors.

Documentation Required for Reimbursement Submission

To ensure your claim is processed smoothly, you must provide the correct employee reimbursement documentation requirements. Without proper proof, an administrator cannot legally approve a tax-free reimbursement.

Types of Receipts and Proof of Purchase

The type of documentation you need depends on the expense.

• For Insurance Premiums: You must provide a document that shows you are enrolled in a qualifying health insurance plan and that you have paid the premium. This can be an invoice from the insurance carrier, a bank statement showing the payment, or an Explanation of Benefits (EOB).
• For Medical Expenses: For services like doctor visits, prescriptions, or dental care, you will need to submit an itemized receipt or an EOB. The document must show the date of service, the service or product received, and the amount you paid. A simple credit card statement is often not enough, as it doesn't detail what the expense was for.

Additional Information Needed

In some cases, you may need to provide more than just a receipt. For instance, some expenses may require a business justification if they are not clearly medical in nature. For ICHRA, the most critical piece of additional information is proof of minimum essential coverage (MEC). You must substantiate that you are enrolled in a valid health insurance plan before your first reimbursement can be approved for the plan year.

Understanding the Reimbursement Approval Process

After you hit "submit," your request begins the health benefits claim approval workflow. This is where your employer or their benefits administrator reviews your submission to confirm it meets all the necessary criteria.

Initial Review by Finance or HR

The first stop for your request is typically an initial review. A designated person in HR, finance, or a third-party administrator will look over your submission to check for completeness. They will ensure all required forms are filled out and all necessary documentation is attached. This initial check helps catch simple errors early, preventing an automatic denial.

Criteria for Approval

For a reimbursement request to be approved, it must meet several key criteria:

• The expense must be eligible. Under ICHRA, this includes individual health insurance premiums and qualified medical expenses as defined by the IRS.
• The employee must be eligible. The person submitting the claim must be an eligible employee under the terms of the benefits plan.
• The documentation must be sufficient. The submitted receipts and proofs of purchase must be clear, legible, and contain all the required information (date, service, amount).
• The request must be submitted on time. Most companies have a deadline for submitting expenses, often within a certain number of days from when the cost was incurred.

Common Reasons for Denial

A reimbursement request can be denied for a few common reasons:

• Missing or Inadequate Documentation: This is the most frequent reason for a denial. A blurry receipt or a missing EOB can halt the process.
• Ineligible Expense: The requested reimbursement is for a product or service not covered under the plan, such as a cosmetic procedure.
• Lack of Insurance Coverage: For ICHRA, if the employee is not enrolled in a qualifying health plan, their claims cannot be reimbursed.
• Duplicate Submission: The employee has already been reimbursed for the same expense.

Approval Workflow for Reimbursement Requests

The approval workflow for reimbursement is a structured process designed to ensure every claim is handled accurately and in compliance with company policy and federal regulations.

Step-by-Step Approval Process

1. Submission: The employee submits the claim and documentation through an online portal, app, or other approved method.
2. Verification: The administrator reviews the submission to verify that the expense is eligible and the documentation is valid. This may involve checking the expense against IRS guidelines for qualified medical costs.
3. Approval or Denial: Based on the verification, the administrator approves or denies the claim. If approved, it moves to the payment stage. If denied, the employee is notified with a reason for the denial and, if applicable, instructions on how to correct and resubmit the claim.
4. Payment: Once approved, the reimbursement amount is issued to the employee. This is typically done through payroll, direct deposit, or a check, depending on the employer's setup.

Who Makes the Final Decision?

The final decision-maker is usually a designated approver. In smaller companies, this might be a manager or someone in the finance department. In larger organizations or companies using a TPA, the administrator has the authority to approve claims that meet the established guidelines. For high-value claims, a multi-level approval process may be in place, requiring a manager or department head to sign off as well.

Tracking Your Reimbursement Request Status

Waiting for a reimbursement can be stressful, but most modern systems offer transparency into the process.

How to Check the Status of Your Request

If your company uses a benefits administration platform, you can usually log in to your account to see the real-time status of your request. The status will typically show whether your claim is "submitted," "in review," "approved," or "paid." If you submitted your request via email or paper, you may need to follow up directly with your HR department or administrator.

Expected Timeframes for Approval

The time it takes to get reimbursed can vary. After you submit your claim with all the necessary documents, the review and approval process generally takes a few business days. Once approved, payment is often issued in the next payroll cycle. While some processes can take up to 20 days, many employers aim to reimburse employees much faster to ensure a positive benefits experience. Using an integrated platform often speeds up this timeline significantly.

Best Practices for Submitting Reimbursement Requests

A little preparation can go a long way in ensuring your reimbursement requests are approved quickly.

Tips for Ensuring Quick Approval

• Submit Promptly: Don’t wait until the last minute. Submit your expenses as soon as possible while the details are still fresh in your mind.
• Review Your Company's Policy: Make sure you understand what is and isn’t a covered expense under your company’s specific plan.
• Keep Digital Copies: Save digital copies of all your receipts and documents. They are easier to store, find, and upload.
• Double-Check Your Submission: Before you hit submit, review all the information for accuracy. Make sure the amounts match and the documents are legible.

Common Mistakes to Avoid

• Submitting Incomplete Forms: A missing field on a form can cause unnecessary delays.
• Uploading the Wrong Document: Attaching a credit card slip instead of an itemized receipt is a common error.
• Assuming an Expense is Covered: Always check your plan’s guidelines before making a purchase if you are unsure if it’s eligible.

Conclusion: Streamlining Your Reimbursement Process

A well-managed reimbursement process is a win-win. Employers can offer flexible, cost-effective health benefits like ICHRA, which helps them attract and retain top talent. Employees get the freedom to choose their own health insurance and are empowered to manage their healthcare spending. By understanding the submission and approval workflow, you can navigate the process with confidence. Using a simple, intuitive platform and following best practices for documentation ensures that you can make the most of your benefits without the administrative headache.