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Limited-Purpose Flexible Spending Account

A limited-purpose FSA is designated for eligible dental, vision, and preventive care expenses only. The limited-purpose FSA allows those with a Health Savings Account (HSA) to use HSA funds for medical expenses and use the limited-purpose FSA funds for eligible expenses such as orthodontia or glasses. Limited-Purpose FSA - Save on Vision and Dental

Am I Eligible for a Limited-Purpose FSA? The limited-purpose FSA is offered by employers to complement a Health Savings Account (HSA). To maximize savings, you can enroll in both a limited-purpose FSA and a dependent care FSA with an HSA. You are not eligible to be enrolled in both a health FSA and a limited-purpose FSA at the same time. • Medical expenses that are not related to dental, vision, or preventive care items and services • Cosmetic Optical Services • Cosmetic Dental Services • Insurance Premiums • Bug Spray • Dental Floss • Teeth Whitening • Tooth Brushes • Toiletries • Toothpaste What Items are NOT Eligible Under a Limited- Purpose FSA? Important Note Regarding Preventive Care Expenses Most preventive care items will require you to submit a claim and provide substantiating documentation to be eligible under the limited-purpose FSA. In some cases, a prescription or letter of medical necessity may also be needed.

The limited-purpose FSA complements a Health Savings Account by allowing you to use funds from your Limited-Purpose FSA for vision, dental, and preventive care expenses you may have normally paid from your HSA. This is a great way to maximize your savings and allow your HSA funds to grow for retirement. You elect the annual amount to contribute and the entire amount is available on the first day of your plan. You may use your plan like an interest-free loan to pay for eligible expenses.

Limited-Purpose FSA Eligible Expenses

The IRS determines what expenses are FSA eligible. Eligible expenses are reimbursed if they are incurred by you, your spouse, or your tax dependents during the plan year. The charts below show examples of eligible and ineligible expenses:

Eligible Dental Expenses

Dental Visits Dental Cleanings Dentures Dental Fillings/Implants

Dental Surgeries Teeth Cleanings Dental Procedures Orthodontia or Braces

Orthodontia Deductibles Dental Coinsurance, Copays and Deductibles

Eligible Vision Expenses

LASIK Surgery Contacts Eye Exams

Eyeglasses Prescription Sunglasses Optical Surgeries

Optical Coinsurance, Copays and Deductibles

Eligible Preventive Care Expenses Allergy Shots Annual Check-Ups

Flu Shots Glucometers Labwork Routine Prenatal Care

Sunscreen Well Child Visits X-rays

Blood Pressure Monitor Diagnostic Procedures

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