Limited Purpose Flexible Spending Account


For Plan C members only


Because Plan C (HDHP) requires you to have a Health Savings Account, those who enroll in this type of plan have the option of a Limited Purpose FSA. The Limited Purpose FSA works the same way a standard FSA does: pre-tax, “use it or lose it” elections and expenses must occur within the plan year.  The difference is that with a Limited Purpose FSA, claims may be submitted for eligible dental and vision expenses only, such as:

  • Dental and orthodontic care such as fillings, X-rays, braces, caps, mouth guards and dentures
  • Vision care, including exams, eyeglasses, contact lenses, solutions and supplies, and LASIK eye surgery
  • Only prescriptions and over-the-counter items related to dental and vision care are reimbursable.

Note: The ASI Debit Card is available with both the Standard Health Care FSA and Limited Purpose Health CareFSA.  Claims may also be submitted via mail or online.


Standard and Limited Purpose Health Care FSA

Health Care Flexible Spending Account

Minimum

Maximum

24 deduction period employees / deduction
24 deduction period employees / per year

$8.00/
$192.00

$104.16/
$2,500.00

16 deduction period (at regents) / deduction
16 deduction period (at regents) / year

$12.00/
$192.00

$156.25/
$2,500.00