The Rise of Holistic HRAs: How Employers Are Quietly Paying for Alternative Wellness
There’s a good chance you have hundreds or even thousands of dollars sitting in a Health Reimbursement Arrangement that you could be using for acupuncture, therapy, fitness classes, or nutritionist consultations—but nobody told you. Most employees think HRAs are just for traditional medical expenses like doctor visits and prescriptions. They don’t realize that many employers have quietly expanded what their HRAs will cover to include a much broader definition of wellness that extends far beyond conventional healthcare (learn more about HRAs here).
This shift is happening largely under the radar. Companies aren’t necessarily announcing “We now cover naturopathic care!” in all-staff emails. Instead, they’re working with progressive benefits administrators to expand eligible expense categories, reclassify certain wellness services as preventive care, and create more flexible definitions of what constitutes a reimbursable health expense. The result is that employees who bother to investigate—or who get creative about how they submit claims—are discovering that their HRA will pay for things they’ve been funding out-of-pocket for years.
The motivation from employers’ perspective is straightforward: they’re recognizing that traditional healthcare alone isn’t keeping employees healthy, productive, or satisfied. Preventive and holistic approaches often address problems before they become expensive medical conditions. An employee who manages stress through regular meditation coaching might avoid the burnout that leads to medical leave. Someone who addresses chronic pain through acupuncture might avoid the opioid prescription that creates worse problems. A worker who improves sleep quality through a structured program might avoid the performance issues and health complications that come with chronic sleep deprivation.
But here’s the frustrating part: most employees don’t know this expanded coverage exists because it’s not clearly communicated. Your benefits guide might list “eligible medical expenses” without explaining that this now includes alternative and preventive wellness services. To learn more about what your specific HRA covers, you often need to proactively contact your benefits administrator and ask explicit questions about categories that aren’t mentioned in standard documentation.
Acupuncture: More Widely Covered Than You Think
Acupuncture has crossed the threshold from “alternative medicine” to mainstream accepted treatment in many HRA programs. If you’re experiencing chronic pain, fertility challenges, migraine headaches, anxiety, or various other conditions, acupuncture treatments from licensed practitioners are increasingly reimbursable through HRAs.
The key is usually licensing. Your acupuncturist needs to be a licensed healthcare provider (LAc or similar credentials depending on your state), and ideally you have documentation that the treatment addresses a specific health condition rather than just general wellness. A note from your primary care doctor recommending acupuncture for chronic back pain strengthens your reimbursement claim significantly.
Acupuncture sessions typically cost $75-150 each, and many practitioners recommend weekly or biweekly sessions for several months to address chronic conditions. Over a year, this can easily reach $2,000-4,000—money you might be able to claim from your HRA instead of paying out-of-pocket.
The catch is that not all HRAs have updated their systems to automatically approve acupuncture claims. You might need to submit with a letter of medical necessity from your provider, or you might get an initial denial that you need to appeal with additional documentation. But the effort is worthwhile given the potential reimbursement amounts.
Naturopathic Care: Growing Acceptance
Naturopathic doctors (NDs) are gaining recognition in HRA coverage, particularly in states where naturopathy is a regulated, licensed profession. If you’re seeing a licensed naturopathic physician for treatment of specific conditions—not just general wellness consultations—there’s a reasonable chance your HRA will cover the visits.
This includes consultations ($150-300), diagnostic testing ordered by your ND, and sometimes even supplements or botanical medicines when prescribed as treatment rather than general wellness support. The distinction between “treatment” and “wellness” is critical—HRAs typically won’t cover general wellness consultations, but they will cover treatment of diagnosed conditions.
Where this gets interesting is that naturopathic doctors often address conditions like digestive issues, hormonal imbalances, chronic fatigue, and autoimmune conditions using approaches different from conventional medicine. If conventional treatments haven’t worked for you, naturopathic care might be worth exploring—and potentially worth submitting to your HRA for reimbursement.
Mental Health Coaching vs. Traditional Therapy
Traditional mental health therapy with licensed therapists (LCSWs, psychologists, psychiatrists) is clearly HRA-eligible. But what about mental health coaching, stress management programs, or wellness coaching that addresses mental health without being traditional therapy?
This is where HRA policies vary widely. Some employers have expanded coverage to include:
Certified health coaches who work on stress management, behavioral change, and wellness goals—particularly when addressing specific health-related concerns rather than general life coaching
Meditation and mindfulness programs with structured curricula, especially those prescribed by healthcare providers or offered through healthcare platforms
Mental health apps with subscription fees, when they provide actual therapeutic content rather than just wellness tracking
Group therapy or support programs facilitated by licensed professionals, even if they’re not traditional one-on-one therapy sessions
The key to getting these expenses covered is usually demonstrating that they’re addressing specific health concerns (anxiety, depression, ADHD, chronic stress) rather than general personal development. Documentation from your doctor recommending these approaches as part of your treatment plan significantly improves approval odds.
Fitness: Beyond the Gym Membership
Most HRAs won’t cover a standard gym membership because it’s considered general wellness rather than treatment for a specific medical condition. But there are exceptions and workarounds that many people don’t know about:
Medically prescribed exercise programs are often covered. If your doctor prescribes exercise as treatment for obesity, diabetes, cardiovascular disease, or other conditions, many HRAs will reimburse fitness-related expenses including gym memberships, personal training, or fitness classes.
Physical therapy alternatives like clinical Pilates, therapeutic yoga, or specialized fitness programs designed to address specific conditions (post-surgery rehabilitation, chronic pain management, injury recovery) are frequently eligible.
Fitness subscriptions with therapeutic elements—like online programs specifically designed for people with chronic conditions, or fitness apps that connect users with physical therapists—sometimes qualify, particularly with medical documentation.
Adaptive fitness equipment prescribed by healthcare providers is typically reimbursable. This includes specialized equipment for people with disabilities or chronic conditions that require modified exercise approaches.
The difference between “I want to get in shape” (not covered) and “My doctor recommended structured exercise to manage my Type 2 diabetes” (potentially covered) is significant. Documentation transforms a general wellness expense into a medical treatment.
Nutritionists and Dietitians: Preventive Care Category
Nutrition counseling from registered dietitians (RDs) or licensed nutritionists has become increasingly recognized as preventive care in HRA programs, particularly when addressing specific health conditions:
Diabetes management nutrition counseling is almost universally covered. If you’re diabetic or pre-diabetic, working with a dietitian to manage blood sugar through diet is clearly medical treatment.
Cardiovascular disease and high cholesterol often qualify for nutrition counseling coverage, as diet is a primary treatment modality for these conditions.
Gastrointestinal conditions like IBS, Crohn’s disease, celiac disease, or food allergies create clear medical necessity for dietitian services.
Eating disorders treatment including nutritional counseling is typically covered as mental health/medical treatment.
Prenatal nutrition counseling during pregnancy often qualifies as preventive care.
Where coverage gets uncertain is general nutrition counseling for people without diagnosed conditions who just want to eat healthier. Some progressive HRAs have moved toward covering this under preventive care, particularly if it’s provided through platforms that track health metrics and demonstrate health improvements. But others maintain that it needs to address a specific medical condition to qualify.
Sessions with nutritionists typically cost $100-200, with initial consultations sometimes higher. A typical treatment plan might involve 4-8 sessions over several months, putting total costs at $500-1,500—meaningful savings if HRA-eligible.
Sleep Programs: The Emerging Category
Sleep disorders have massive health and productivity implications, and forward-thinking employers are recognizing that addressing sleep problems is legitimate healthcare spending. This opens the door for HRA coverage of:
Cognitive behavioral therapy for insomnia (CBT-I) programs, which are increasingly available through digital platforms and apps. These structured programs ($300-1,000) have strong clinical evidence and are being recognized as medical treatment for insomnia.
Sleep studies and equipment are clearly covered—CPAP machines, oral appliances for sleep apnea, and diagnostic sleep tests are standard HRA-eligible expenses.
Sleep coaching programs that go beyond general sleep hygiene to provide structured intervention for sleep problems are gaining coverage, particularly when provided by healthcare professionals or through medical platforms.
The key is framing sleep programs as treatment for a medical condition (insomnia, sleep apnea, shift work sleep disorder) rather than general wellness optimization.
Stress Reduction: The Documentation Game
Stress management is increasingly recognized as preventive healthcare, but getting HRA reimbursement requires strategic documentation. Services that might qualify include:
Mindfulness-based stress reduction (MBSR) programs with evidence-based curricula, particularly when recommended by healthcare providers
Biofeedback training for stress management, when provided by licensed professionals
Massage therapy when prescribed by your doctor for treatment of specific conditions (chronic pain, injury recovery, anxiety disorders)—not general relaxation
Meditation apps or programs when part of a treatment plan for diagnosed conditions like anxiety or hypertension
The pattern across all stress-reduction expenses is that general wellness doesn’t qualify, but treatment of specific conditions does. A massage because you’re stressed isn’t covered. A massage prescribed by your doctor as part of anxiety disorder treatment might be.
How to Navigate Holistic HRA Claims
Start with your benefits administrator: Call and ask specifically about each category you’re interested in. Don’t accept “we cover medical expenses” as a complete answer—ask about acupuncture specifically, about nutrition counseling, about mental health coaching.
Get documentation from providers: A letter from your doctor explaining why they’re recommending acupuncture, nutrition counseling, or stress management programs significantly improves approval odds.
Submit claims clearly: Explain what the expense is for and why it addresses a specific health condition. Don’t assume the benefits administrator will understand from cryptic charge descriptions.
Be prepared to appeal: Initial denials are common for non-traditional expenses. Appeal with additional documentation and explanation of medical necessity.
Track what gets approved: Once you successfully get something approved, you know that category is fair game for future expenses.
The landscape of HRA-eligible expenses is expanding faster than most employees realize. The benefits you’re already entitled to might extend far beyond what you’re currently using. The money is sitting there—you just need to know it exists and how to access it.
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