Health Reimbursement Arrangement (HRA)

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 July 1, 2016, the Health Reimbursement Arrangement (HRA) will be administered by UltraBenefits.

Although the plan administrator has changed, the HRA plan will continue to reimburse eligible out-of-pocket expenses as it previously has:
  • Level 1: High Cost Co-payment
  • Level 2: Out-of-Pocket Expenses.

Helpful Information


HRA Explained


Summary and overview of the Health Reimbursement Arrangement (HRA) benefits.

HRA Attestation Form


Use this form to assist with tracking out-of-pocket expenses.

HRA Manual Claim Form


Use this form to submit claims manually via fax or mail.

Claim Assistance


Employees are encouraged to contact Samantha Letourneau at UltraBenefits directly at 866-858-7223, ext. 68109 for claim related assistance. Employees may also contact Human Relations at 978-674-4105 for general assistance. 
  
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.