Sunday, 22 January 2017
1. What is a Limited Purpose Medical FSA?

A Limited Purpose FSA is a Medical FSA designed to allow Health Savings Account (HSA) participants an opportunity to set aside pre-tax funds to pay for out-of-pocket vision, dental and preventive care services.

2. What specific expenses are eligible for reimbursement from a Limited Purpose Medical FSA?

Vision Care: Out-of-pocket expenses for LASIK surgery, eye exams, eye glasses (frames & lenses), contact lenses & solution, prescription sunglasses, safety glasses and over-the-counter reading glasses.

Dental Care: Out-of-pocket expenses for dental cleanings, fluoride treatments, extractions, x-rays, fillings, crowns, bridges, dentures, denture adhesives, implants and orthodontia.

Preventive Care: Out-of-pocket expenses for periodic health exams, tests and diagnostic procedures in conjunction with evaluation, well-baby care, immunizations for adults and children, tobacco cessation and weight loss programs for obesity.

3. May I be reimbursed for expenses incurred by my dependents?

Yes, your federal tax dependents may have their expenses reimbursed from your Limited Purpose Medical FSA regardless of whether or not they are covered under your health plan.

4. When may I use funds in my Limited Purpose Medical FSA general out-of-pocket medical expenses, such as deductible expenses and/or over-the-counter medicines?

Your FSA remains limited to vision, dental & preventive care until you have incurred the minimum out-of-pocket deductible expenses as required by the IRS. These amounts are as follows:


Minimum Out-of Pocket Deductible Expense Amount - Single Coverage

Minimum Out-of-Pocket Deductible Expense Amount - Family Coverage




2010 - 2012









For example, if you are enrolled by yourself in a high deductible health plan in 2015 and are contributing to an HSA, you are eligible for reimbursement of vision, dental or preventive care expenses after you have incurred $1300 in out-of-pocket deductible expenses.

5. If my spouse is not enrolled in an HSA-qualified health plan and does not contribute to an HSA, may I use money in my limited medical FSA for his/her general medical expenses?

No. Current IRS regulations prohibit this practice.

6. How do I file a claim with GDI?

Please complete the Limited Purpose FSA claim form, sign and date it and include your itemized receipts for eligible services. You may fax, scan and email, or mail your claims to us. See the claim form for more information.

7. How will GDI know that I have met my minimum deductible and am now eligible to be reimbursed for general medical expenses?

You will need to obtain an “EOB” (Explanation of Benefits) from your health insurance carrier as it will indicate that you have met the mandatory amount of deductible expenses. This information is required each time you submit a reimbursement request for general medical expenses.