Overview

You can use your Limited Purpose Health Care FSA (LPFSA) funds to pay for a wide variety of health care products and services for you, your spouse, and your dependents. The IRS determines which expenses can be reimbursed by an LPFSA.

Eligibility

Qualifying Person

Qualified medical expenses can be incurred by the following persons:

1. You and your spouse.

2. All dependents you claim on your tax return.

3. Any person you could have claimed as a dependent on your return except that:

   a. The person filed a joint return;

   b. The person had gross income of $4,300 or more; or

   c. You, or your spouse if filing jointly could be claimed as a dependent on someone else’s tax return.

For this purpose, a child of parents that are divorced, separated, or living apart for the last 6 months of the calendar year is treated as the dependent of both parents whether or not the custodial parent releases the claim to the child’s exemption.

Qualifying Expense

You can use your LPFSA to pay for eligible expenses under the four categories:

1. Vision
2. Dental

Please see the below table to find out more details.

V: Items/Services that are eligible with a detailed receipt.

X: Items/Services that are not eligible.

Rx: Items/Services that are eligible with a prescription from your doctor, in addition to a detailed receipt.

LMN: Items/Services that are eligible with a detailed receipt and a Letter of Medical Necessity, signed by your doctor.

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