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BMO U.S. Benefits

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. Your Spending Account (YSA) administers the plan.

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 $2,750.
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/or domestic partner’s children qualify as your tax dependents, their expenses are eligible to be claimed under your LPFSA.

Reimbursement
  • As you incur eligible expenses during the plan year, submit LPFSA claim forms to YSA 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.
YSA Debit Card
  • If you contribute $150 or more to your LPFSA, you can use the prepaid YSA card to pay for eligible dental and vision expenses.
  • If you are also participating in the HSA, your YSA 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 and Forfeit of Funds
  • The LPFSA allows up to $500 of unused funds to be carried over into the next plan year.
  • IRS regulations require that any amount over the allowed carry over amount be forfeited by December 31st if not used for reimbursement of eligible expenses
  • You must submit claims for eligible expenses by April 30th of the following calendar year.

Manage your LPFSA

Here's how you can view and track your Limited Purpose Flexible Spending Account and submit claims on YSA:

  • Go to Workday, click My Benefits & Retirement application
  • Select your network status (on or off the BMO network)
  • Click Access Your Spending Account (YSA) tile