Health Reimbursement Arrangement (HRA) Forms
Partial Listing of 213(d) Eligible Medical Expenses
Premium Only Listing of Eligible Expenses
Health Reimbursement Arrangement Non-Recurring Claim Form
Expenses must be incurred prior to submitting a request for reimbursement. Approved HRA claims are processed within 7 – 14 business days.
Health Reimbursement Arrangement Recurring Claim Form
Per IRS regulations, you must provide monthly documentation showing that your expenses were incurred.
Health Reimbursement Authorization for Direct Deposit Form
Once your claim has been processed, it may take up to 72 hours for the funds to post to your designated bank account.
AUL Investment Change and Transfer Form
This form may be used only if your funds are invested in AUL’s variable product and your Plan allows for diversification of funds.
