Some benefit plans release funds based on contribution amounts throughout the year instead of all at once. When a member on one of these plans submits a claim for more than their current available balance, but within their total benefit amount, it's processed as an accrual claim.
When accrual claims are enabled, members can submit claims that exceed their available balance, up to the full amount their plan provides for the year. This is most common for directed spend, dependent care FSA benefits, HRAs, LSAs, rewards benefits.
When an accrual claim is approved, the available balance is paid out immediately. The remaining approved amount is held in a pending state and paid automatically as new funds are added to the member's account through payroll deductions or employer contributions. How to enable accrual claims
Partner admins can enable or disable accrual claims from the Benefit Builder.
Partner Administrator Feature
This feature is only available for partner admins. It is not available for organization admins.
Select the Benefit Builder from the navigation menu.
Select the benefit template you want to update.
Navigate to the Claims section.
Toggle accrual claims on or off.
Select Save.
Note: Admins must add a plan end date to enable accrual claims.
Accrual claims are on by default for HRA, DCFSA, LSA, Rewards, Remote Work, and Directed Spend plans.
You cannot enable or disable accrual claims for active benefit plans. Accrual claims adjustments cannot be made during the plan year. Adjustments must be made prior to the plan start date.
How accrual claims work in the Health Wallet
When an accrual claim is approved, the full claim amount is debited from the member's available balance. If the available balance is insufficient to cover the full amount, members will be told that the amount exceeds their available balance, and, if approved, the claim will be paid out automatically as funds become available.
As new contributions are added to the member’s account, they’re applied to the balance of approved claims first, reducing the outstanding amount until the claim is fully paid. Members can submit new claims up to their plan limit regardless of the status of other approved claims.
Messages members will see when submitting a claim
When a member submits a claim, they’ll be shown one of three responses based on their available balance and plan limit:
“This amount is covered by your available balance of [total available balance]. If approved, it will be paid automatically.”
“This amount exceeds your available balance of [amount]. If approved, the claim will be paid out up to the approved amount automatically as funds become available.”
“This amount exceeds your plan limit of [amount]. They can submit up to [plan limit dollar amount]. Please adjust to continue.”
Once a member submits a claim, it will go through the standard review process. If approved, available funds will be paid out right away, and the remaining balance will be held as pending.
Maximum claim amount:
Members can't submit a claim for more than the limit shown on their benefit card.
Understanding claim limits:
Depending on their benefit, members may see a plan limit or an election amount on their benefit card. This is the maximum they can submit for.
Here’s an example of what members with DC-FSA benefit with accrual claims enabled will see:
What you'll see in Health Wallet Manager
For each member with an active accrual claim, you'll see the following in their account details:
Available balance
Total accrued claim obligations outstanding
For each accrual claim, you'll see:
The total claim amount
The amount paid to date and the date of each payment
The remaining amount pending
Note for admins managing multiple organizations:
To view accrual claim details for a specific member, choose the appropriate organization from the Organizations tab.
Accrual claims in reports
Accrual claim data is included in claims reports. Reports display both paid and pending claim amounts so you have a complete view of financial obligations across your plans.
Things to keep in mind
Claims that exceed a member's total plan election amount are rejected at submission.
If a member's benefit is terminated, any unpaid portions of a pending accrual claim will be canceled or handled according to plan rules.
A member's debit card balance will show $0.00 while an accrual claim is active. This is expected behavior. New contributions are applied to the outstanding claim first and are not available on the card until the claim is fully paid.