{"id":20275,"date":"2019-11-21T14:24:02","date_gmt":"2019-11-21T19:24:02","guid":{"rendered":"https:\/\/gtm.com\/household\/?page_id=20275"},"modified":"2019-11-21T14:43:39","modified_gmt":"2019-11-21T19:43:39","slug":"qsehra-employer-enrollment","status":"publish","type":"page","link":"https:\/\/gtm.com\/household\/qsehra-employer-enrollment\/","title":{"rendered":"QSEHRA Employer Enrollment"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;3.22&#8243; custom_padding=&#8221;5px||5px|&#8221; custom_padding_tablet=&#8221;50px|0|50px|0&#8243; custom_padding_phone=&#8221;&#8221; transparent_background=&#8221;off&#8221; padding_mobile=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;3.25&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; 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use_border_color=&#8221;off&#8221;]<\/p>\n<h1><span style=\"color: #ff6a02;\">QSEHRA Employer Enrollment Form<\/span><\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; specialty=&#8221;on&#8221; custom_padding_last_edited=&#8221;on|desktop&#8221; parallax_method_1=&#8221;off&#8221; parallax_method_2=&#8221;off&#8221; admin_label=&#8221;section&#8221; _builder_version=&#8221;3.22&#8243; custom_padding=&#8221;5px||10px|&#8221; custom_padding_tablet=&#8221;50px|0|50px|0&#8243; custom_padding_phone=&#8221;&#8221; transparent_background=&#8221;off&#8221; padding_mobile=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221;][et_pb_column type=&#8221;3_4&#8243; specialty_columns=&#8221;3&#8243; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_row_inner padding_mobile=&#8221;off&#8221; column_padding_mobile=&#8221;on&#8221; admin_label=&#8221;Row&#8221; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|35px||&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;3.0.47&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.0.6&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; z_index_tablet=&#8221;500&#8243; hover_enabled=&#8221;0&#8243; text_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; text_text_shadow_vertical_length_tablet=&#8221;0px&#8221; text_text_shadow_blur_strength_tablet=&#8221;1px&#8221; link_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; link_text_shadow_vertical_length_tablet=&#8221;0px&#8221; link_text_shadow_blur_strength_tablet=&#8221;1px&#8221; ul_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; ul_text_shadow_vertical_length_tablet=&#8221;0px&#8221; ul_text_shadow_blur_strength_tablet=&#8221;1px&#8221; ol_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; ol_text_shadow_vertical_length_tablet=&#8221;0px&#8221; ol_text_shadow_blur_strength_tablet=&#8221;1px&#8221; quote_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; quote_text_shadow_vertical_length_tablet=&#8221;0px&#8221; quote_text_shadow_blur_strength_tablet=&#8221;1px&#8221; header_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; header_text_shadow_vertical_length_tablet=&#8221;0px&#8221; header_text_shadow_blur_strength_tablet=&#8221;1px&#8221; header_2_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; header_2_text_shadow_vertical_length_tablet=&#8221;0px&#8221; header_2_text_shadow_blur_strength_tablet=&#8221;1px&#8221; header_3_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; header_3_text_shadow_vertical_length_tablet=&#8221;0px&#8221; header_3_text_shadow_blur_strength_tablet=&#8221;1px&#8221; header_4_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; header_4_text_shadow_vertical_length_tablet=&#8221;0px&#8221; header_4_text_shadow_blur_strength_tablet=&#8221;1px&#8221; header_5_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; header_5_text_shadow_vertical_length_tablet=&#8221;0px&#8221; header_5_text_shadow_blur_strength_tablet=&#8221;1px&#8221; header_6_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; header_6_text_shadow_vertical_length_tablet=&#8221;0px&#8221; header_6_text_shadow_blur_strength_tablet=&#8221;1px&#8221; box_shadow_horizontal_tablet=&#8221;0px&#8221; box_shadow_vertical_tablet=&#8221;0px&#8221; box_shadow_blur_tablet=&#8221;40px&#8221; box_shadow_spread_tablet=&#8221;0px&#8221; use_border_color=&#8221;off&#8221;]Complete the form below to get started with offering a QSEHRA to your employees.<\/p>\n<p>If you have any questions, contact our insurance team at (800) 929-9213 or <a href=\"mailto:InsuranceClientService@gtm.com\">InsuranceClientService@gtm.com<\/a>.<\/p>\n<p><div class=\"frm_forms  with_frm_style frm_style_divi\" id=\"frm_form_14_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_qkoti2\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">QSEHRA Employer Enrollment Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"14\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_14\" id=\"frm_hide_fields_14\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"qkoti2\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_14\" name=\"frm_submit_entry_14\" value=\"91ef3a21e9\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/household\/wp-json\/wp\/v2\/pages\/20275\" \/><div id=\"frm_field_151_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Employer Information for Plan Documents<\/h3>\r\n\r\n\r\n<div id=\"frm_field_144_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_nhtc52\" class=\"frm_primary_label\">Employer Name (First and Last)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nhtc52\" name=\"item_meta[144]\" value=\"\"  data-sectionid=\"151\"  data-reqmsg=\"Employer Name (First and Last) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employee Name (First and Last) is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_148_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9saaz2\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_9saaz2_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_148-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_9saaz2_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_line1\" value=\"\" name=\"item_meta[148][line1]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_148-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_9saaz2_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_line2\" value=\"\" name=\"item_meta[148][line2]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_148-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_9saaz2_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_city\" value=\"\" name=\"item_meta[148][city]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_148-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_9saaz2_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t\t<select name=\"item_meta[148][state]\" id=\"field_9saaz2_state\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Alabama\">Alabama<\/option><option  value=\"Alaska\">Alaska<\/option><option  value=\"Arkansas\">Arkansas<\/option><option  value=\"Arizona\">Arizona<\/option><option  value=\"California\">California<\/option><option  value=\"Colorado\">Colorado<\/option><option  value=\"Connecticut\">Connecticut<\/option><option  value=\"Delaware\">Delaware<\/option><option  value=\"District of Columbia\">District of Columbia<\/option><option  value=\"Florida\">Florida<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Hawaii\">Hawaii<\/option><option  value=\"Idaho\">Idaho<\/option><option  value=\"Illinois\">Illinois<\/option><option  value=\"Indiana\">Indiana<\/option><option  value=\"Iowa\">Iowa<\/option><option  value=\"Kansas\">Kansas<\/option><option  value=\"Kentucky\">Kentucky<\/option><option  value=\"Louisiana\">Louisiana<\/option><option  value=\"Maine\">Maine<\/option><option  value=\"Maryland\">Maryland<\/option><option  value=\"Massachusetts\">Massachusetts<\/option><option  value=\"Michigan\">Michigan<\/option><option  value=\"Minnesota\">Minnesota<\/option><option  value=\"Mississippi\">Mississippi<\/option><option  value=\"Missouri\">Missouri<\/option><option  value=\"Montana\">Montana<\/option><option  value=\"Nebraska\">Nebraska<\/option><option  value=\"Nevada\">Nevada<\/option><option  value=\"New Hampshire\">New Hampshire<\/option><option  value=\"New Jersey\">New Jersey<\/option><option  value=\"New Mexico\">New Mexico<\/option><option  value=\"New York\">New York<\/option><option  value=\"North Carolina\">North Carolina<\/option><option  value=\"North Dakota\">North Dakota<\/option><option  value=\"Ohio\">Ohio<\/option><option  value=\"Oklahoma\">Oklahoma<\/option><option  value=\"Oregon\">Oregon<\/option><option  value=\"Pennsylvania\">Pennsylvania<\/option><option  value=\"Rhode Island\">Rhode Island<\/option><option  value=\"South Carolina\">South Carolina<\/option><option  value=\"South Dakota\">South Dakota<\/option><option  value=\"Tennessee\">Tennessee<\/option><option  value=\"Texas\">Texas<\/option><option  value=\"Utah\">Utah<\/option><option  value=\"Vermont\">Vermont<\/option><option  value=\"Virginia\">Virginia<\/option><option  value=\"Washington\">Washington<\/option><option  value=\"West Virginia\">West Virginia<\/option><option  value=\"Wisconsin\">Wisconsin<\/option><option  value=\"Wyoming\">Wyoming<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_148-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_9saaz2_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_zip\" value=\"\" name=\"item_meta[148][zip]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_149_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_rx2kz2\" class=\"frm_primary_label\">Phone Number:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_rx2kz2\" name=\"item_meta[149]\" value=\"\"  data-sectionid=\"151\"  data-reqmsg=\"Phone Number: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone Number is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_155_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_bq6h92\" class=\"frm_primary_label\">Email Address:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_bq6h92\" name=\"item_meta[155]\" value=\"\"  data-sectionid=\"151\"  data-reqmsg=\"Email Address: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_157_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Effective Date<\/h3>\r\n<div id=\"frm_desc_field_ghyjj2\" class=\"frm_description frm_section_spacing\">You can go as far back as the beginning of the current month<\/div>\r\n\r\n<div id=\"frm_field_187_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_eq4jc\" id=\"field_eq4jc_label\" class=\"frm_primary_label\">Effective Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eq4jc\" name=\"item_meta[187]\" value=\"06\/18\/2026\"  data-sectionid=\"157\"  maxlength=\"10\" data-frmval=\"06\/18\/2026\" data-reqmsg=\"Effective Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_189_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Plan Year<\/h3>\r\n\r\n\r\n<div id=\"frm_field_192_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_tuu4h_label\" class=\"frm_primary_label\">The first plan year will be:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tuu4h_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_192-189-0\">\t\t\t<label  for=\"field_tuu4h-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[192]\" id=\"field_tuu4h-0\" value=\"A 12-month consecutive period\"\n\t\t data-sectionid=\"189\"  data-reqmsg=\"The first plan year will be: cannot be blank.\" data-invmsg=\"The first plan year will be: is invalid\"   \/> A 12-month consecutive period<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_192-189-1\">\t\t\t<label  for=\"field_tuu4h-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[192]\" id=\"field_tuu4h-1\" value=\"A short plan year\"\n\t\t data-sectionid=\"189\"  data-reqmsg=\"The first plan year will be: cannot be blank.\" data-invmsg=\"The first plan year will be: is invalid\"   \/> A short plan year<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_193_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_p4n9z\" id=\"field_p4n9z_label\" class=\"frm_primary_label\">Beginning Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p4n9z\" name=\"item_meta[193]\" value=\"06\/18\/2026\"  data-sectionid=\"189\"  maxlength=\"10\" data-frmval=\"06\/18\/2026\" data-reqmsg=\"Beginning Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_194_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_eu194\" id=\"field_eu194_label\" class=\"frm_primary_label\">Ending Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eu194\" name=\"item_meta[194]\" value=\"06\/18\/2026\"  data-sectionid=\"189\"  maxlength=\"10\" data-frmval=\"06\/18\/2026\" data-reqmsg=\"Ending Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_195_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Waiting and Eligibility Requirements<\/h3>\r\n\r\n\r\n<div id=\"frm_field_196_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_cxxcx_label\" class=\"frm_primary_label\">Employees are eligible to participate in the plan on:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_cxxcx_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_196-195-0\">\t\t\t<label  for=\"field_cxxcx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[196]\" id=\"field_cxxcx-0\" value=\"First day of employment\"\n\t\t data-sectionid=\"195\"  data-reqmsg=\"Employees are eligible to participate in the plan on: cannot be blank.\" data-invmsg=\"Employees are eligible to participate in the plan on: is invalid\"   \/> First day of employment<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_196-195-1\">\t\t\t<label  for=\"field_cxxcx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[196]\" id=\"field_cxxcx-1\" value=\"First day of the month following the start of employment\"\n\t\t data-sectionid=\"195\"  data-reqmsg=\"Employees are eligible to participate in the plan on: cannot be blank.\" data-invmsg=\"Employees are eligible to participate in the plan on: is invalid\"   \/> First day of the month following the start of employment<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_196-195-2\">\t\t\t<label  for=\"field_cxxcx-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[196]\" id=\"field_cxxcx-2\" value=\"First day of the month following _____ days of employment [enter number of days below]\"\n\t\t data-sectionid=\"195\"  data-reqmsg=\"Employees are eligible to participate in the plan on: cannot be blank.\" data-invmsg=\"Employees are eligible to participate in the plan on: is invalid\"   \/> First day of the month following _____ days of employment [enter number of days below]<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_200_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_l0ims\" id=\"field_l0ims_label\" class=\"frm_primary_label\">Number of days of employment\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_l0ims\" name=\"item_meta[200]\" value=\"\" data-sectionid=\"195\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_201_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_8ymii\" id=\"field_8ymii_label\" class=\"frm_primary_label\">All employees who work _____ or more hours per week are eligible [enter number of hours below]\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_8ymii\" name=\"item_meta[201]\" value=\"\" data-sectionid=\"195\"  data-reqmsg=\"All employees who work _____ or more hours per week are eligible [enter number of hours below] cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_179_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Plan Options<\/h3>\r\n\r\n\r\n<div id=\"frm_field_202_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_lq5tz_label\" class=\"frm_primary_label\">Annual benefit limit:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_lq5tz_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_202-179-0\">\t\t\t<label  for=\"field_lq5tz-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[202]\" id=\"field_lq5tz-0\" value=\"Maximum allowed ($5,250\/individual or $10,600\/family)\"\n\t\t data-sectionid=\"179\"  data-reqmsg=\"Annual benefit limit: cannot be blank.\" data-invmsg=\"Annual benefit limit: is invalid\"   \/> Maximum allowed ($5,250\/individual or $10,600\/family)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_202-179-1\">\t\t\t<label  for=\"field_lq5tz-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[202]\" id=\"field_lq5tz-1\" value=\"Other amount [enter below]\"\n\t\t data-sectionid=\"179\"  data-reqmsg=\"Annual benefit limit: cannot be blank.\" data-invmsg=\"Annual benefit limit: is invalid\"   \/> Other amount [enter below]<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_5nj06\" id=\"field_5nj06_label\" class=\"frm_primary_label\">Other amount\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_5nj06\" name=\"item_meta[203]\" value=\"\" data-sectionid=\"179\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_w01qk_label\" class=\"frm_primary_label\">Will the funds be available:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_w01qk_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_204-0\">\t\t\t<label  for=\"field_w01qk-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[204]\" id=\"field_w01qk-0\" value=\"Monthly\"\n\t\t data-reqmsg=\"Will the funds be available: cannot be blank.\" data-invmsg=\"Will the funds be available: is invalid\"   \/> Monthly<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_204-1\">\t\t\t<label  for=\"field_w01qk-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[204]\" id=\"field_w01qk-1\" value=\"As a lump sum\"\n\t\t data-reqmsg=\"Will the funds be available: cannot be blank.\" data-invmsg=\"Will the funds be available: is invalid\"   \/> As a lump sum<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_60c3e_label\" class=\"frm_primary_label\">Will the plan reimbursement be for:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_60c3e_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_205-0\">\t\t\t<label  for=\"field_60c3e-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[205]\" id=\"field_60c3e-0\" value=\"Premium only\"\n\t\t data-reqmsg=\"Will the plan reimbursement be for: cannot be blank.\" data-invmsg=\"Will the plan reimbursement be for: is invalid\"   \/> Premium only<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_205-1\">\t\t\t<label  for=\"field_60c3e-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[205]\" id=\"field_60c3e-1\" value=\"Premium and\/or IRS 213(d) medical, dental, and vision expenses\"\n\t\t data-reqmsg=\"Will the plan reimbursement be for: cannot be blank.\" data-invmsg=\"Will the plan reimbursement be for: is invalid\"   \/> Premium and\/or IRS 213(d) medical, dental, and vision expenses<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_206_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_c1xn5_label\" class=\"frm_primary_label\">Will the plan carry over unused funds at the end of the plan year?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_c1xn5_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_206-0\">\t\t\t<label  for=\"field_c1xn5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[206]\" id=\"field_c1xn5-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Will the plan carry over unused funds at the end of the plan year? cannot be blank.\" data-invmsg=\"Will the plan carry over unused funds at the end of the plan year? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_206-1\">\t\t\t<label  for=\"field_c1xn5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[206]\" id=\"field_c1xn5-1\" value=\"No\"\n\t\t data-reqmsg=\"Will the plan carry over unused funds at the end of the plan year? cannot be blank.\" data-invmsg=\"Will the plan carry over unused funds at the end of the plan year? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_270_container\" class=\"frm_form_field form-field  frm_none_container\">\n\t<label for=\"g-recaptcha-response\" id=\"field_60moz_label\" class=\"frm_primary_label\">Captcha\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<div  id=\"field_60moz\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdWXIUrAAAAAB5_QnNn5DAWvL8xVQnPWdneZDd5\" data-size=\"invisible\" data-theme=\"light\"><\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_269_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit Form<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_279_container\">\n\t\t\t<label for=\"field_kxmtm\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_kxmtm\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[279]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"c4SrdL3NHMUVgjF\/ztaUwFNpQpgxpkuHvIMU6WJ3K1L+XBqE6FyRkcykSNcIBTjx\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;B&#038;I Pages list&#8221; _builder_version=&#8221;4.0.6&#8243; text_font_size=&#8221;16px&#8221; text_line_height=&#8221;1.5em&#8221; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; module_alignment=&#8221;left&#8221; ul_font_size_last_edited=&#8221;off|desktop&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#e5e5e5&#8243; border_style=&#8221;solid&#8221; global_module=&#8221;8673&#8243; saved_tabs=&#8221;all&#8221;]<\/p>\n<h4><strong>Household Employee Benefits &amp; Insurance<\/strong><\/h4>\n<ul>\n<li><a href=\"\/household\/health-insurance\/\">Health Insurance<\/a><\/li>\n<li><a href=\"\/household\/dental-vision\/\">Dental &amp; Vision Benefits<\/a><\/li>\n<li><a href=\"\/household\/benefits-insurance\/virtual-medicine\/\">Virtual Medicine<\/a><\/li>\n<li><a href=\"\/household\/benefits-insurance\/QSEHRA\/\">Small Employer HRAs (QSEHRA)<\/a><\/li>\n<li><a href=\"\/household\/health-reimbursement-arrangements\/\">Health Reimbursement Arrangements (HRA)<\/a><\/li>\n<li><a href=\"\/household\/flexible-spending-accounts\/\">Flexible Spending Accounts (FSA)<\/a><\/li>\n<li><a href=\"\/household\/retirement-plan\/\">Retirement Plan<\/a><\/li>\n<li><a href=\"\/household\/workers-compensation\/\">Workers&#8217; Compensation Insurance<\/a><\/li>\n<li><a href=\"\/household\/benefits-insurance\/travel-insurance\/\">Travel Insurance<\/a><\/li>\n<li><a href=\"\/household\/benefits-insurance\/employee-dishonesty-insurance\/\">Employee Dishonesty Insurance<\/a><\/li>\n<li><a href=\"\/household\/benefits-insurance\/other-insurance\/\">Other Insurance<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;3.22&#8243; custom_padding=&#8221;10px|||&#8221; custom_padding_tablet=&#8221;50px|0|50px|0&#8243; custom_padding_phone=&#8221;&#8221; transparent_background=&#8221;off&#8221; padding_mobile=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;3.25&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.0.47&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_divider color=&#8221;#efefef&#8221; disabled_on=&#8221;on|on|off&#8221; _builder_version=&#8221;3.2&#8243; hide_on_mobile=&#8221;on&#8221;]<br \/>\n[\/et_pb_divider][et_pb_text admin_label=&#8221;Talk to an Expert&#8221; _builder_version=&#8221;3.27.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221;]<\/p>\n<h2>Talk to an Expert<\/h2>\n<p>Our employee benefits experts are available to discuss your needs and help you get started with a Health Reimbursement Arrangement or other benefits.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_3,1_3,1_3&#8243; padding_mobile=&#8221;off&#8221; column_padding_mobile=&#8221;on&#8221; _builder_version=&#8221;3.22&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221; global_module=&#8221;9357&#8243;][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;3.0.47&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_blurb image=&#8221;\/household\/wp-content\/uploads\/chat-icon-2.png&#8221; image_max_width=&#8221;none&#8221; admin_label=&#8221;chat Blurb&#8221; _builder_version=&#8221;3.0.87&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; animation=&#8221;off&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221;][\/et_pb_blurb][et_pb_button button_url=&#8221;#&#8221; button_text=&#8221;Chat Online Now&#8221; button_alignment=&#8221;center&#8221; module_class=&#8221;chatting-button&#8221; _builder_version=&#8221;3.16&#8243; background_layout=&#8221;dark&#8221; button_letter_spacing_hover=&#8221;0&#8243; saved_tabs=&#8221;all&#8221; button_text_size__hover_enabled=&#8221;off&#8221; button_text_size__hover=&#8221;null&#8221; button_one_text_size__hover_enabled=&#8221;off&#8221; button_one_text_size__hover=&#8221;null&#8221; button_two_text_size__hover_enabled=&#8221;off&#8221; button_two_text_size__hover=&#8221;null&#8221; button_text_color__hover_enabled=&#8221;off&#8221; button_text_color__hover=&#8221;null&#8221; button_one_text_color__hover_enabled=&#8221;off&#8221; button_one_text_color__hover=&#8221;null&#8221; button_two_text_color__hover_enabled=&#8221;off&#8221; button_two_text_color__hover=&#8221;null&#8221; button_border_width__hover_enabled=&#8221;off&#8221; button_border_width__hover=&#8221;null&#8221; button_one_border_width__hover_enabled=&#8221;off&#8221; button_one_border_width__hover=&#8221;null&#8221; button_two_border_width__hover_enabled=&#8221;off&#8221; button_two_border_width__hover=&#8221;null&#8221; button_border_color__hover_enabled=&#8221;off&#8221; button_border_color__hover=&#8221;null&#8221; button_one_border_color__hover_enabled=&#8221;off&#8221; button_one_border_color__hover=&#8221;null&#8221; button_two_border_color__hover_enabled=&#8221;off&#8221; button_two_border_color__hover=&#8221;null&#8221; button_border_radius__hover_enabled=&#8221;off&#8221; button_border_radius__hover=&#8221;null&#8221; button_one_border_radius__hover_enabled=&#8221;off&#8221; button_one_border_radius__hover=&#8221;null&#8221; button_two_border_radius__hover_enabled=&#8221;off&#8221; button_two_border_radius__hover=&#8221;null&#8221; button_letter_spacing__hover_enabled=&#8221;on&#8221; button_letter_spacing__hover=&#8221;0&#8243; button_one_letter_spacing__hover_enabled=&#8221;off&#8221; button_one_letter_spacing__hover=&#8221;null&#8221; button_two_letter_spacing__hover_enabled=&#8221;off&#8221; button_two_letter_spacing__hover=&#8221;null&#8221; button_bg_color__hover_enabled=&#8221;off&#8221; button_bg_color__hover=&#8221;null&#8221; button_one_bg_color__hover_enabled=&#8221;off&#8221; button_one_bg_color__hover=&#8221;null&#8221; button_two_bg_color__hover_enabled=&#8221;off&#8221; button_two_bg_color__hover=&#8221;null&#8221;][\/et_pb_button][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;3.0.47&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_blurb image=&#8221;\/household\/wp-content\/uploads\/phone-icon-2.png&#8221; image_max_width=&#8221;none&#8221; admin_label=&#8221;call us Blurb&#8221; _builder_version=&#8221;3.0.87&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; text_orientation=&#8221;center&#8221; animation=&#8221;off&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221;]<\/p>\n<p>\nCall Us<br \/><span style=\"color: #ff6a02;\"><strong><a style=\"color: #ff6a02;\" href=\"tel:\/\/1(800) 929-9213\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-size: 1.3em;\">(800) 929-9213<\/span><\/a><\/strong><\/span><br \/>Mon \u2013 Thurs 8:30 am \u2013 8 pm ET<br \/>Fri 8:30 am \u2013 6 pm ET<\/p>\n<p>[\/et_pb_blurb][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;3.0.47&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_blurb image=&#8221;\/household\/wp-content\/uploads\/dollar-thumbnail.png&#8221; image_max_width=&#8221;none&#8221; admin_label=&#8221;get quote Blurb&#8221; _builder_version=&#8221;3.0.87&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; animation=&#8221;off&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221;][\/et_pb_blurb][et_pb_button button_url=&#8221;\/household\/benefits-insurance\/get-a-quote\/&#8221; button_text=&#8221;Get a Quote&#8221; button_alignment=&#8221;center&#8221; _builder_version=&#8221;3.16&#8243; 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button_bg_color__hover_enabled=&#8221;off&#8221; button_bg_color__hover=&#8221;null&#8221; button_one_bg_color__hover_enabled=&#8221;off&#8221; button_one_bg_color__hover=&#8221;null&#8221; button_two_bg_color__hover_enabled=&#8221;off&#8221; button_two_bg_color__hover=&#8221;null&#8221;][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>QSEHRA Employer Enrollment Form Complete the form below to get started with offering a QSEHRA to your employees. If you have any questions, contact our insurance team at (800) 929-9213 or InsuranceClientService@gtm.com. <div class=\"frm_forms  with_frm_style frm_style_divi\" id=\"frm_form_14_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_qkoti2\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">QSEHRA Employer Enrollment Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"14\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_14\" id=\"frm_hide_fields_14\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"qkoti2\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_14\" name=\"frm_submit_entry_14\" value=\"91ef3a21e9\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/household\/wp-json\/wp\/v2\/pages\/20275\" \/><div id=\"frm_field_151_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Employer Information for Plan Documents<\/h3>\r\n\r\n\r\n<div id=\"frm_field_144_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_nhtc52\" class=\"frm_primary_label\">Employer Name (First and Last)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nhtc52\" name=\"item_meta[144]\" value=\"\"  data-sectionid=\"151\"  data-reqmsg=\"Employer Name (First and Last) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Employee Name (First and Last) is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_148_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9saaz2\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <fieldset aria-labelledby=\"field_9saaz2_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_148-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_9saaz2_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_line1\" value=\"\" name=\"item_meta[148][line1]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_148-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_9saaz2_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_line2\" value=\"\" name=\"item_meta[148][line2]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_148-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_9saaz2_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_city\" value=\"\" name=\"item_meta[148][city]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_148-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_9saaz2_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t\t<select name=\"item_meta[148][state]\" id=\"field_9saaz2_state\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Alabama\">Alabama<\/option><option  value=\"Alaska\">Alaska<\/option><option  value=\"Arkansas\">Arkansas<\/option><option  value=\"Arizona\">Arizona<\/option><option  value=\"California\">California<\/option><option  value=\"Colorado\">Colorado<\/option><option  value=\"Connecticut\">Connecticut<\/option><option  value=\"Delaware\">Delaware<\/option><option  value=\"District of Columbia\">District of Columbia<\/option><option  value=\"Florida\">Florida<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Hawaii\">Hawaii<\/option><option  value=\"Idaho\">Idaho<\/option><option  value=\"Illinois\">Illinois<\/option><option  value=\"Indiana\">Indiana<\/option><option  value=\"Iowa\">Iowa<\/option><option  value=\"Kansas\">Kansas<\/option><option  value=\"Kentucky\">Kentucky<\/option><option  value=\"Louisiana\">Louisiana<\/option><option  value=\"Maine\">Maine<\/option><option  value=\"Maryland\">Maryland<\/option><option  value=\"Massachusetts\">Massachusetts<\/option><option  value=\"Michigan\">Michigan<\/option><option  value=\"Minnesota\">Minnesota<\/option><option  value=\"Mississippi\">Mississippi<\/option><option  value=\"Missouri\">Missouri<\/option><option  value=\"Montana\">Montana<\/option><option  value=\"Nebraska\">Nebraska<\/option><option  value=\"Nevada\">Nevada<\/option><option  value=\"New Hampshire\">New Hampshire<\/option><option  value=\"New Jersey\">New Jersey<\/option><option  value=\"New Mexico\">New Mexico<\/option><option  value=\"New York\">New York<\/option><option  value=\"North Carolina\">North Carolina<\/option><option  value=\"North Dakota\">North Dakota<\/option><option  value=\"Ohio\">Ohio<\/option><option  value=\"Oklahoma\">Oklahoma<\/option><option  value=\"Oregon\">Oregon<\/option><option  value=\"Pennsylvania\">Pennsylvania<\/option><option  value=\"Rhode Island\">Rhode Island<\/option><option  value=\"South Carolina\">South Carolina<\/option><option  value=\"South Dakota\">South Dakota<\/option><option  value=\"Tennessee\">Tennessee<\/option><option  value=\"Texas\">Texas<\/option><option  value=\"Utah\">Utah<\/option><option  value=\"Vermont\">Vermont<\/option><option  value=\"Virginia\">Virginia<\/option><option  value=\"Washington\">Washington<\/option><option  value=\"West Virginia\">West Virginia<\/option><option  value=\"Wisconsin\">Wisconsin<\/option><option  value=\"Wyoming\">Wyoming<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_148-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_9saaz2_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_9saaz2_zip\" value=\"\" name=\"item_meta[148][zip]\"  data-sectionid=\"151\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_149_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_rx2kz2\" class=\"frm_primary_label\">Phone Number:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_rx2kz2\" name=\"item_meta[149]\" value=\"\"  data-sectionid=\"151\"  data-reqmsg=\"Phone Number: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone Number is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_155_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_bq6h92\" class=\"frm_primary_label\">Email Address:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_bq6h92\" name=\"item_meta[155]\" value=\"\"  data-sectionid=\"151\"  data-reqmsg=\"Email Address: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_157_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Effective Date<\/h3>\r\n<div id=\"frm_desc_field_ghyjj2\" class=\"frm_description frm_section_spacing\">You can go as far back as the beginning of the current month<\/div>\r\n\r\n<div id=\"frm_field_187_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_eq4jc\" id=\"field_eq4jc_label\" class=\"frm_primary_label\">Effective Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eq4jc\" name=\"item_meta[187]\" value=\"06\/18\/2026\"  data-sectionid=\"157\"  maxlength=\"10\" data-frmval=\"06\/18\/2026\" data-reqmsg=\"Effective Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_189_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Plan Year<\/h3>\r\n\r\n\r\n<div id=\"frm_field_192_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_tuu4h_label\" class=\"frm_primary_label\">The first plan year will be:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tuu4h_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_192-189-0\">\t\t\t<label  for=\"field_tuu4h-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[192]\" id=\"field_tuu4h-0\" value=\"A 12-month consecutive period\"\n\t\t data-sectionid=\"189\"  data-reqmsg=\"The first plan year will be: cannot be blank.\" data-invmsg=\"The first plan year will be: is invalid\"   \/> A 12-month consecutive period<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_192-189-1\">\t\t\t<label  for=\"field_tuu4h-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[192]\" id=\"field_tuu4h-1\" value=\"A short plan year\"\n\t\t data-sectionid=\"189\"  data-reqmsg=\"The first plan year will be: cannot be blank.\" data-invmsg=\"The first plan year will be: is invalid\"   \/> A short plan year<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_193_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_p4n9z\" id=\"field_p4n9z_label\" class=\"frm_primary_label\">Beginning Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p4n9z\" name=\"item_meta[193]\" value=\"06\/18\/2026\"  data-sectionid=\"189\"  maxlength=\"10\" data-frmval=\"06\/18\/2026\" data-reqmsg=\"Beginning Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_194_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_eu194\" id=\"field_eu194_label\" class=\"frm_primary_label\">Ending Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eu194\" name=\"item_meta[194]\" value=\"06\/18\/2026\"  data-sectionid=\"189\"  maxlength=\"10\" data-frmval=\"06\/18\/2026\" data-reqmsg=\"Ending Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_195_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Waiting and Eligibility Requirements<\/h3>\r\n\r\n\r\n<div id=\"frm_field_196_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_cxxcx_label\" class=\"frm_primary_label\">Employees are eligible to participate in the plan on:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_cxxcx_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_196-195-0\">\t\t\t<label  for=\"field_cxxcx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[196]\" id=\"field_cxxcx-0\" value=\"First day of employment\"\n\t\t data-sectionid=\"195\"  data-reqmsg=\"Employees are eligible to participate in the plan on: cannot be blank.\" data-invmsg=\"Employees are eligible to participate in the plan on: is invalid\"   \/> First day of employment<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_196-195-1\">\t\t\t<label  for=\"field_cxxcx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[196]\" id=\"field_cxxcx-1\" value=\"First day of the month following the start of employment\"\n\t\t data-sectionid=\"195\"  data-reqmsg=\"Employees are eligible to participate in the plan on: cannot be blank.\" data-invmsg=\"Employees are eligible to participate in the plan on: is invalid\"   \/> First day of the month following the start of employment<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_196-195-2\">\t\t\t<label  for=\"field_cxxcx-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[196]\" id=\"field_cxxcx-2\" value=\"First day of the month following _____ days of employment [enter number of days below]\"\n\t\t data-sectionid=\"195\"  data-reqmsg=\"Employees are eligible to participate in the plan on: cannot be blank.\" data-invmsg=\"Employees are eligible to participate in the plan on: is invalid\"   \/> First day of the month following _____ days of employment [enter number of days below]<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_200_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_l0ims\" id=\"field_l0ims_label\" class=\"frm_primary_label\">Number of days of employment\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_l0ims\" name=\"item_meta[200]\" value=\"\" data-sectionid=\"195\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_201_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_8ymii\" id=\"field_8ymii_label\" class=\"frm_primary_label\">All employees who work _____ or more hours per week are eligible [enter number of hours below]\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_8ymii\" name=\"item_meta[201]\" value=\"\" data-sectionid=\"195\"  data-reqmsg=\"All employees who work _____ or more hours per week are eligible [enter number of hours below] cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_179_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Plan Options<\/h3>\r\n\r\n\r\n<div id=\"frm_field_202_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_lq5tz_label\" class=\"frm_primary_label\">Annual benefit limit:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_lq5tz_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_202-179-0\">\t\t\t<label  for=\"field_lq5tz-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[202]\" id=\"field_lq5tz-0\" value=\"Maximum allowed ($5,250\/individual or $10,600\/family)\"\n\t\t data-sectionid=\"179\"  data-reqmsg=\"Annual benefit limit: cannot be blank.\" data-invmsg=\"Annual benefit limit: is invalid\"   \/> Maximum allowed ($5,250\/individual or $10,600\/family)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_202-179-1\">\t\t\t<label  for=\"field_lq5tz-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[202]\" id=\"field_lq5tz-1\" value=\"Other amount [enter below]\"\n\t\t data-sectionid=\"179\"  data-reqmsg=\"Annual benefit limit: cannot be blank.\" data-invmsg=\"Annual benefit limit: is invalid\"   \/> Other amount [enter below]<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_5nj06\" id=\"field_5nj06_label\" class=\"frm_primary_label\">Other amount\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_5nj06\" name=\"item_meta[203]\" value=\"\" data-sectionid=\"179\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_w01qk_label\" class=\"frm_primary_label\">Will the funds be available:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_w01qk_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_204-0\">\t\t\t<label  for=\"field_w01qk-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[204]\" id=\"field_w01qk-0\" value=\"Monthly\"\n\t\t data-reqmsg=\"Will the funds be available: cannot be blank.\" data-invmsg=\"Will the funds be available: is invalid\"   \/> Monthly<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_204-1\">\t\t\t<label  for=\"field_w01qk-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[204]\" id=\"field_w01qk-1\" value=\"As a lump sum\"\n\t\t data-reqmsg=\"Will the funds be available: cannot be blank.\" data-invmsg=\"Will the funds be available: is invalid\"   \/> As a lump sum<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_60c3e_label\" class=\"frm_primary_label\">Will the plan reimbursement be for:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_60c3e_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_205-0\">\t\t\t<label  for=\"field_60c3e-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[205]\" id=\"field_60c3e-0\" value=\"Premium only\"\n\t\t data-reqmsg=\"Will the plan reimbursement be for: cannot be blank.\" data-invmsg=\"Will the plan reimbursement be for: is invalid\"   \/> Premium only<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_205-1\">\t\t\t<label  for=\"field_60c3e-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[205]\" id=\"field_60c3e-1\" value=\"Premium and\/or IRS 213(d) medical, dental, and vision expenses\"\n\t\t data-reqmsg=\"Will the plan reimbursement be for: cannot be blank.\" data-invmsg=\"Will the plan reimbursement be for: is invalid\"   \/> Premium and\/or IRS 213(d) medical, dental, and vision expenses<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_206_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_c1xn5_label\" class=\"frm_primary_label\">Will the plan carry over unused funds at the end of the plan year?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_c1xn5_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_206-0\">\t\t\t<label  for=\"field_c1xn5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[206]\" id=\"field_c1xn5-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Will the plan carry over unused funds at the end of the plan year? cannot be blank.\" data-invmsg=\"Will the plan carry over unused funds at the end of the plan year? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_206-1\">\t\t\t<label  for=\"field_c1xn5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[206]\" id=\"field_c1xn5-1\" value=\"No\"\n\t\t data-reqmsg=\"Will the plan carry over unused funds at the end of the plan year? cannot be blank.\" data-invmsg=\"Will the plan carry over unused funds at the end of the plan year? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_270_container\" class=\"frm_form_field form-field  frm_none_container\">\n\t<label for=\"g-recaptcha-response\" id=\"field_60moz_label\" class=\"frm_primary_label\">Captcha\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<div  id=\"field_60moz\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdWXIUrAAAAAB5_QnNn5DAWvL8xVQnPWdneZDd5\" data-size=\"invisible\" data-theme=\"light\"><\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_269_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit Form<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_280_container\">\n\t\t\t<label for=\"field_9j47i\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_9j47i\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[280]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"c4SrdL3NHMUVgjF\/ztaUwFNpQpgxpkuHvIMU6WJ3K1IlJUy\/GUATV3VkXgF4UxWQ\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\nHousehold Employee Benefits &amp; Insurance Health Insurance Dental &amp; Vision Benefits Virtual Medicine Small Employer HRAs (QSEHRA) Health Reimbursement Arrangements (HRA) Flexible [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":30,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<img class=\"alignleft size-medium wp-image-2886 img-rounded\" alt=\"health reimbursement arrangements\" src=\"http:\/\/108.166.11.61\/household\/wp-content\/uploads\/prod-drug-prescription-300x199.jpg\" width=\"300\" height=\"199\" \/>Health Reimbursement Arrangements (HRAs) are a creative option for household employers with a range of budgets who want to offer a contribution program for health-related expenses as an employee benefit.\r\n\r\nGTM is offering household employers a revolutionary way to help provide healthcare benefits to your employee.\r\n\r\nHRA's have been\u00a0the best option for\u00a0healthcare benefits in the household employment industry for many years - whether you use an HRA as a standalone option or combine it with a major medical insurance plan.\r\n\r\n<b>HRAs are flexible, convenient, and cost-effective, offering:<\/b>\r\n<ul>\r\n\t<li>Freedom of choice to help control healthcare costs for your employee<\/li>\r\n\t<li>Freedom of control,\u00a0making your employee accountable for the management of their medical treatments<\/li>\r\n\t<li>Convenient roll-over feature so you don't lose your contributions at the end of the year or when an employee leaves<\/li>\r\n\t<li>Flexible budget options - contribution amounts that you determine<\/li>\r\n\t<li>Versatility- an HRA can be used alongside other savings accounts and health options and can be used to fund insurance premiums and deductibles<\/li>\r\n\t<li>Popular with the employee - HRAs use employer contributions,\u00a0not employee salary deductions<\/li>\r\n<\/ul>\r\nHRAs allow employees and employers to take advantage of the lower premiums offered by high-deductible major medical plans and help keep healthcare costs under control.\u00a0 The employee becomes more self-reliant, aware of healthcare issues, and develops better judgment with health-related costs and arrangements.\r\n\r\nThe employer offers a useable, affordable employment benefit to their employee that helps recruit and retain the best employees, but doesn't break the bank.\r\n\r\n[accordion title=\"WHAT'S INVOLVED?\" style=\"default-style\"]\r\n<b>Employer contribution<\/b>\r\n<ul>\r\n\t<li>Define an amount per year you want to contribute for your employee(s)<\/li>\r\n\t<li>Set up a GTM HRA account. Your contribution is automatically drawn into a GTM account for your employee on a pay period basis<\/li>\r\n\t<li>Inform your employee of the contribution amount and how they can use the money<\/li>\r\n\t<li>Check quarterly GTM statements to keep track of the account<\/li>\r\n<\/ul>\r\n\u00a0\r\n\r\n<b>Employee tasks<\/b>\r\n<ul>\r\n\t<li>Read and understand the HRA account plans and what medical expenses are eligible for reimbursement<\/li>\r\n\t<li>Keep a receipt and record of medical expenses for you and your dependents<\/li>\r\n\t<li>Send in claims for reimbursement promptly<\/li>\r\n\t<li>Access the HRA account online to manage expenses<\/li>\r\n<\/ul>\r\n[\/accordion]\r\n\r\n\u00a0\r\n\r\n<strong>If you are interested in the HRA options listed above, please contact us at (888)432-7972.<\/strong>","_et_gb_content_width":"","footnotes":""},"folder":[],"class_list":["post-20275","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast 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