Artificial Reproduction: HSA Eligibility

Artificial reproduction is eligible if the procedure is required to overcome a medical condition in order to conceive. In most cases, reimbursement will require a Letter of Medical Necessity (LMN) from a doctor with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Artificial reproduction is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

What is artificial reproduction?

Artificial reproduction, also known as intrauterine insemination, is a treatment for infertility and ideally will make pregnancy possible for women who aren't able to conceive through normal intercourse. During this procedure, sperm are inserted directly into the cervix, fallopian tubes or uterus to bypass any possible obstructions to egg fertilization. This procedure follows a series of cycles, or the time from a patient's first day of a period, ovulation, insemination and finally concluding with a pregnancy test. This process only takes a few minutes, but patients will typically take fertility drugs for about a week before the procedure to improve their chances of conception.

What health issues does artificial reproduction overcome?

Artificial reproduction is only eligible for reimbursement under an FSA, HSA, or HRA if it is used to overcome a legitimate medical condition that prevents conception. However, these medical conditions aren't completely limited to women. Whether a man or woman is a consumer spending account holder, the couple's reasons for choosing artificial reproduction will be covered as long as they relate to a medical issue that interferes with a couple's ability to conceive. Some examples of potential medical conditions include:

  • Low sperm counts
  • Poor sperm motility
  • Semen allergies
  • Sexually-transmitted diseases (STDs)
  • Severe pain during sex
  • Erectile dysfunction (ED)
  • Cervical scarring or cervical abnormalities

How is a Letter of Medical Necessity (LMN) obtained for artificial reproduction?

For artificial reproduction to be eligible for reimbursement, it must be used to treat or prevent a specific medical condition or illness. To ensure that the expense will be reimbursed, it's recommended that account holders obtain a Letter of Medical Necessity (LMN) from a physician that can be submitted to a benefits administrator, as well as providing additional documentation for tax purposes.

This letter must outline how an account holder or spouse's medical condition prevents conception artificial reproduction is necessary to become pregnant. The letter must outline how the treatment will be used to alleviate the issue and how long the treatment will last. If the treatment plan exceeds the current plan year, another LMN will have to be provided to the benefits administrator to cover the duration of the treatment.

Eligibility Table

Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)

Eligible

Eligible with Rx

Eligible with LMN

Not Eligible

 


AZ-PROD-WEB02 11/18/2017 9:55:58 AM