FSAs, HSAs, and HRAs

What are FSAs, HSAs, and HRAs?

As part of an employee benefit package, an employer might offer one or a combination of the following healthcare options:

  • A Healthcare Flexible Spending Account (FSA) is an employer-sponsored account that allows you to put aside a portion of your paycheck each month (pre-tax) to cover medical expenses. Note that Healthcare FSAs do not travel with you from employer to employer, and they reset each year; if you don’t use your funds before December 31st or before you change jobs, you will lose those funds.

  • Like an FSA, a Health Savings Account (HSA) is also an employer-sponsored, pre-tax account for covering health expenses, which you can pay into each month directly from your paycheck. Although HSAs are administered by your employers, you own the account: the funds you place in your HSA are accessible to you year over year, even if you change jobs or health plans.

  • A Health Reimbursement Arrangement (HRA) is an employer-funded health plan that will reimburse you for qualified medical expenses. HRA funds can roll over year to year, so you may not lose them if you don’t spend them by December 31st. However, because HRAs are owned as well as operated by employers, the funds in your HRA won’t go with you if you leave your role and join another company.

How do I use my FSA, HSA, or HRA to pay for Alma sessions?

There are 3 ways that you can use your benefits to pay for Alma sessions:

  1. Pay Alma with your FSA, HSA, or HRA debit card,
  2. Apply for reimbursement from your FSA, HSA, or HRA plan, or
  3. Allow your health plan to coordinate in-network benefits internally
    (Note that this last option has several requirements to be applicable!)

If your benefit plan exclusively issues physical checks, you can still pay your Alma invoices with a personal credit or debit card and then submit directly to your FSA, HSA, or HRA plan for reimbursement. See “the section titled "Reimbursement" below for more details.

Option 1: Debit Cards

Alma accepts FSA, HSA, or HRA debit cards. You can enter your debit card number directly into Alma’s payment systems by following the instructions in Alma’s email invoices. 

That said, we do not currently accept FSA, HSA, or HRA debit cards for autopay enrollment. You can still use your debit card to pay your Alma invoices manually.

If you want to enroll in autopay and use your FSA, HSA, or HRA benefits, you can also pay your invoices with a personal card and submit your receipts to your health plan for reimbursement. 

Splitting Payments

Currently, Alma’s payment system is not set up to support splitting payments for client invoices. We cannot apply partial balances from FSA, HSA, or HRA funds or debit cards to outstanding invoices.

Option 2: Reimbursement

In most cases, Alma is not able to work directly with your FSA, HSA, or HRA for invoice payment. This is because:

  • Alma has a limited view into FSAs, HSAs, or HRAs and the current funding status of these accounts that may pay for your claims.
  • Alma cannot coordinate directly with payers who are not active insurance partners with Alma. (Common examples of plans we are not partnered with include Beacon Health and ConnectYourCare.)

However, you can still use your FSA, HSA, or HRA benefits for Alma sessions by submitting for reimbursement. 

Receipts for Reimbursement

To ensure smooth coordination of services, we strongly recommend that you pay your Alma invoices up front with a personal credit or debit card. (Note that we do not accept personal checks.) 

Once you have paid your Alma invoices, you will receive an email receipt that includes everything you need to file for reimbursement for your payment responsibility from your FSA, HSA, or HRA. If there is any additional information your plan requires, you can send us a note at support@helloalma.com with the request. 

For specific information on how to submit your receipts to your plan, reach out to your FSA, HSA, or HRA fund directly. Your employer’s HR administrator or benefits manager should have contact information for your plan on file.

Explanation of Benefits (EOBs) and Reimbursement

Note that some FSA, HSA, and HRA funds require an EOB (Explanation of Benefits) from your primary health plan before they will reimburse your invoices for Alma services.

You will receive your EOB directly from your insurance company once they have completed processing the claim for your session(s). You can find your insurance company’s contact information on the back of your insurance card, or you can reach out to your employer’s HR administrator for details. 

Generally, it can take up to 45-60 days from when your provider submits a claim until an EOB is available. If your provider is new to Alma’s Insurance Program, read Alma’s Claims Processing to understand why the timeline for EOBs may be a bit longer. You can also find more information on the Alma claims process here: In-network Clients: Understanding your insurance

Option 3: Coordination Among Benefits Within Your Health Plan

This payment option is only available under very specific circumstances. If your FSA, HSA, or HRA plan is managed by an insurance company that is:

  1. Partnered with Alma, and
  2. Also overseeing your primary health plan
    (e.g., if you have an HSA and a primary insurance policy both managed by United Healthcare),

then Alma may be able to work directly with your health plan to get reimbursed for part or all of your payment responsibility. This would mean that you do not need to submit any additional payment or documentation to receive your benefits.

If you have a health plan that is in-network with Alma AND an FSA, HSA, or HRA run by the same insurance company, then you would not need to submit receipts or otherwise create your own request for reimbursement.

Instead, when Alma submits your provider’s claim to your insurance, your insurance company would process all of your benefits internally, notify Alma of the applicable FSA, HSA, or HRA benefit, and submit payment to Alma on your behalf. 


Let’s take the example of Jane Doe, a client who has an HSA and a health plan both run by United Healthcare (UHC) to illustrate how this combination of benefits works.

  • Jane works with a mental health provider who is in-network with UHC through Alma. 
  • Based on Jane’s benefits, Jane’s payment responsibility is a $25 copay
  • Following a session with Jane, their provider uses Alma to submit an insurance claim for their services
  • Alma directs the provider’s insurance claim to UHC (as Jane’s primary health plan) and invoices Jane for the $25 copay. 
  • UHC processes the provider’s insurance claim. Since UHC manages both Jane’s primary health plan and Jane’s HSA, UHC coordinates internally:
    • They process the insurance claim
    • They pay the $25 copay from Jane’s HSA directly to Alma
  • Alma receives the processed claim from UHC, and Jane’s HSA payment 
  • Alma adjusts Jane’s copay invoice accordingly, either by canceling the outstanding invoice or refunding the copay amount if Jane has already completed payment

Key Takeaways


In the case that your insurance company manages both your primary health plan and your FSA, HSA, or HRA benefits, this coordination can have an impact on the timeline of payment for Alma invoices. 

Alma allows 60 days from the initial date of service for payment of client invoices. Your Alma invoices will only be paid once the insurance claim has processed and been returned to Alma, which may take up to 60 days from the date the claim is filed and, in some cases, longer. 

Overdue payment of client invoices can impact your provider, so it is important that you discuss this timeline with them before moving forward. 

There are options under “Client Invoicing” below to pay promptly while still being reimbursed by your FSA, HSA, or HRA.  

Client Invoicing

In this example, Jane received an invoice even though UHC wound up covering the whole cost of the session. Why? 

When Alma runs an eligibility check on a client’s insurance, we will notify both the client and the provider of the client’s payment responsibility for in-network care. This payment responsibility is also the amount that Alma invoices clients after the visit occurs. 

Additional employer benefits, such as FSAs, HSAs, and HRAs, are often highly customized and individualized. Alma does not have visibility into these plans before we submit claims, even if we are partnered with the network payer that manages them. 

This is why you, as a client, may receive an invoice up front from Alma even if, ultimately, your payment responsibility may be covered by your in-network FSA, HSA, and HRA. 

In this scenario, you’ve got 2 options for managing these Alma invoices:

  1. You can pay the invoice directly to Alma with a personal credit or debit card and then wait for reimbursement from Alma once the claim processes and your insurance company applies your FSA, HSA, or HRA funds.
  2. You can wait to pay the invoices until your insurance company completes processing the claim and returns their Explanation of Benefits (EOB) with your FSA, HSA, or HRA funds. While your claim is processing, you will continue to receive weekly Alma invoice reminders via email, which you can disregard.

However, note that Option 2 can affect the timeline of payment for Alma invoices, which may have an impact on your provider. (See the section titled "Timeline" above.) Your provider may also have their own practice rules about when invoices need to be paid, which will need to be taken into account.

For both of these reasons, it is essential that you discuss these invoice payment options with your provider. You can confirm the best option for both of you before moving forward.

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