Investigational Surgery: FSA Eligibility

Investigational surgery is an eligible medical expense with a flexible spending account (FSA), health savings account (HSA) and a health reimbursement arrangement (HRA). Investigational surgery reimbursement is not eligible with a limited care flexible spending account (LCFSA) or a dependent care flexible spending account (DCFSA).

What is investigational surgery?

Investigational surgery, also known as experimental surgery, is the medical term given to surgeries and other procedures that are not "reasonable and necessary" for the diagnosis or treatment of an injury or illness. Additionally, the term "investigational" also is a much broader medical term which refers to any technology, be it a service, supply, procedure, treatment, drug, device, facility, equipment or biological product that is still in a developmental stage or has not been proven to improve the recipient's health outcomes would be considered "investigational."

While investigational surgery techniques are typically a gray area in terms of insurance coverage, if an FSA, HSA or HRA account holder wishes to choose an investigational surgery technique to treat a legitimate medical condition, this would be eligible for reimbursement through their consumer-directed healthcare accounts. In some cases, benefits administrators may request a Letter of Medical Necessity (LMN) to outline how this type of investigational surgery will be used to treat a legitimate medical condition, but in the vast majority of cases, investigational surgery will be fully covered with an FSA, HSA or HRA.

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 11/19/2017 10:40:31 AM