Limited Purpose Flexible Spending Account

Limited Purpose FSA funds can be used to pay for eligible dental and vision expenses, and eligible medical expenses that exceed your deductible.

FSAs come with these tax advantages*:

• Money GOES INTO your account before taxes.

• Money COMES OUT tax-free when spent on eligible expenses.

Limited Purpose FSAs are compatible with a Health Savings Account (HSA) — you can have both accounts at the same time.

Iron Mountain FSAs are administered by Fidelity.

*Tax advantages described here are for federal income tax purposes only. State income tax treatment of contributions and earnings may vary. Check with your tax advisor for more information.

• Eligibility

  You can have a Limited Purpose FSA if you’re enrolled in the Enhanced HDHP or Basic HDHP Medical Plans.

• How it works

  Here’s how you can use a Limited Purpose Health Care FSA.

  Contribute

  Elect your contribution amount annually during Open Enrollment. You can only make changes during the year if you experience a qualifying life event.

  You can contribute up to $3,200. The money will be deducted from your paychecks in equal amounts throughout the year before taxes are calculated. Your eligible expenses must be incurred by December 31.

  Pay

  Use your Fidelity debit card to pay for dental and vision expenses, and eligible medical expenses that exceed your deductible.

  Remember to save any itemized receipts or Explanation of Benefits (EOBs) statements to verify your claims as required by the IRS.

  Spend

  Funds can be used only for eligible health care expenses incurred by March 15, but you must submit claims to Fidelity by the dates noted below. If you don’t incur expenses and submit them for reimbursement per the deadlines outlined below, you’ll forfeit your balances.

  Claims Incurred	Deadline to Submit Claims to Fidelity
  January 1, 2024 – March 15, 2025	March 31, 2025

  For more information, contact Fidelity.

  For a full list of eligible expenses, view IRS Publication 502.

  To review the legal requirements governing health FSAs, see IRS Publication 969.