Retiree | Former Employee | Future Employee

Home > Benefits & Retirement > Limited Purpose Flexible Spending Account

Limited Purpose Flexible Spending Account

The Limited Purpose Flexible Spending Account (LPFSA) works with your HSA to provide additional tax savings for eligible dental and vision expenses.
Smart-Choice Accounts is the administrator.

You may participate in the LPFSA to save money on eligible dental and vision expenses and preserve your HSA balance for medical expenses. LPFSA contributions are deducted before-tax from your paycheck, which reduces your taxable income and increases your take-home pay.

Here’s a high-level overview of the LPFSA. For details, review the Flexible Spending Account SPD.

Features
Contributions to your Account
  • LPFSA contributions are deducted before-tax from your paycheck, which reduces your taxable income.
  • The minimum contribution is $100 per year and the maximum is $3,200 in 2024.
Eligible Expenses Use the LPFSA to pay for or reimburse yourself on a before-tax basis for eligible expenses such as:
  • Deductibles/coinsurance/copayments for dental and vision expenses
  • Expenses not paid or partially paid by your dental plan, including orthodontia (cosmetic dental work, teeth whitening, are not considered eligible expenses)
  • Vision expenses, such as exams, eyeglasses, contact lenses and vision correction surgery
IRS Publication 502 has a complete list of eligible and ineligible expenses.

If your domestic partner and domestic partner’s children qualify as your tax dependents, you can claim their expenses under your LPFSA.
Reimbursement
  • As you incur eligible expenses during the plan year, submit LPFSA claim forms to Smart-Choice Accounts along with your receipts for expenses.
  • You’ll be reimbursed from your account up to the total amount you elected for the plan year and any carry over amount (if applicable), even if you haven’t contributed the full amount at the time of your request.
Debit Card
  • If you contribute $150 or more to your LPFSA, you can use the prepaid debit card to pay for eligible dental and vision expenses.
  • If you are also participating in the HSA, your card will be stacked with both your HSA and LPFSA amounts. Eligible dental and vision expenses will be applied against your LPFSA balance first.
Carry Over of Funds You may carry over up to $640 from one year to the next. Amounts over the limit are forfeited.

Manage your LPFSA

View and track your LPFSA and submit claims on Smart-Choice Accounts.
  • Go to Workday, click My Benefits & Retirement application
  • Select your network status (on or off the BMO network)
  • Click Reimbursement Accounts tile

Related Links

Workday

Important Forms/Docs

Flexible Spending Account SPD

Health Care (Limited Purpose) FSA Claim Form