Fitness Programs: FSA Eligibility

Fitness programs may be eligible for the treatment of a medical condition when accompanied with a prescription or a Letter of Medical Necessity (LMN) with a flexible spending account (FSA), health savings account (HSA) or a health reimbursement arrangement (HRA). Fitness programs reimbursement is not eligible with a dependent care flexible spending account (DCFSA) or a limited care flexible spending account (LCFSA). In order to be reimbursed, an FSA or HRA administrator may require that you prove that not only is the primary purpose of the fitness program for diagnosis, cure, mitigation or treatment of a medical condition, but that you would not have participated in the fitness program “but for” that medical condition.

Can fitness programs treat a medical condition?

The fitness industry has grown by leaps and bounds in recent decades as individuals from all walks of life seek to improve their overall health and wellness. While regular exercise can dramatically reduce an individual's chances of developing heart disease, diabetes and lung disease, the IRS considers these activities conducive to fostering a person's "general health," and does not directly work to treat a legitimate medical condition.

However, in some cases, fitness programs can be a major facet of an individual's medical treatment plan as a response to a major surgery, recovery from a serious illness or other forms of rehabilitative care. These fitness programs can be held at physical training and medical fitness facilities, and these programs follow the continuing care model with techniques developed by medical professionals to treat specific conditions. Additionally, these facilities differ greatly from standard gyms thanks to their expansive resources, such as a network of medical professionals for future referrals, as well as fitness staff that is degreed and certified to practice physical therapy or rehabilitative medicine (Mayo Clinic).

How do I obtain a Letter of Medical Necessity for fitness programs?

If doctors recommend the services of a physical trainer or rehabilitation specialist in the form of fitness programs to help a patient recover from a major illness, surgery or other condition, a Letter of Medical Necessity (LMN) must be obtained for reimbursement through an FSA, HSA or HRA. This letter must outline how an account holder's needs for help, related to their medical condition, necessitates the use of fitness programs; how the fitness programs will be used to alleviate the issue; and how the fitness programs will be used.

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

Specifically Not Covered

Not eligible for general use and well-being.

 


AZ-PROD-WEB02 7/18/2018 3:00:44 AM