Preexisting Condition: FSA Eligibility

Expenses associated with a preexisting medical condition not covered by insurance are eligible for reimbursement with a flexible spending account (FSA), health savings account (HSA), or a health reimbursement arrangement (HRA). Expenses associated with a preexisting medical condition not covered by insurance are not eligible with a dependent care flexible spending account (DCFSA), or a limited care flexible spending account (LCFSA).

What is a pre-existing medical condition?

Due to health care reform, most health insurance coverage plans won't have a pre-existing condition limitation. However, if they do, the cost associated with a pre-existing condition not covered by a primary insurance plan is eligible for reimbursement with a consumer-directed healthcare account.

A pre-existing medical condition is normally defined as a medical condition that occurred before a program of health benefits went into effect. In the context of healthcare in the United States, health care expenses for pre-existing medical conditions were generally not covered in health insurance plans. The primary reason for this was to protect the financial stability of health care insurance providers, who would otherwise be forced to reimburse the healthcare expenses of individuals who purchased health insurance knowing they would receive reimbursement for the expenses for their condition. As of January 1st, 2014, this is no longer legal in the United States. Instead, thanks to the Patient Protection and Affordable Care Act, also known as the ACA or Obamacare, new minimum requirements for accepting patients are in place for all health insurance providers. Pre-existing medical conditions are one example of a cost factor that a health insurance provider must now cover expenses for.

If for any reason a health insurance provider has not covered expenses related to a pre-existing medical condition, then those expenses are eligible for reimbursement with a consumer-directed healthcare account.

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-WEB01 11/18/2017 8:02:46 AM