Preventive Care: FSA Eligibility

Private Letter Ruling 200140017

What is preventive care?

Preventive care is a medical term that refers to preventing disease and helping doctors find problems before symptoms emerge. Preventive care (HealthCare.gov) normally refers to things like immunizations, lab tests, physical exams, and prescriptions .

What are Immunizations?

Immunizations are a form of preventive care. They are administered by a process called vaccination. Immunizations are biologically prepared treatments that work with the body's immune system to provide an active, acquired immunity to a specific disease. Immunizations utilize the body's biological defenses by providing a weakened version of a disease, a microorganism that causes the disease, or a toxin or protein associated with that disease. The body's immune system is able to recognize and defeat and keep a record of the encounter with that disease, and will be able to fight off illness caused by that disease in the future, even if a stronger form of the disease arrives. Some diseases are more easily immunized against than others (World Health Organization).

Childhood immunizations are common, considered safe, and standard for families in the United States. Childhood immunizations have prevented the spread of certain diseases in the modern world and effectively eradicated several others as well. Childhood immunizations are used for diseases such as smallpox, measles, mumps, rubella, polio, and typhoid.

Other immunizations include seasonal vaccination against the flu virus, which requires seasonal re-vaccination.

What are Lab Tests?

Lab tests provide preventive care such as screenings and tests for suspected diseases or medical conditions that are likely for a given demographic, based on age, gender, risk factors, etc. Examples of preventive care for which a lab test might be conducted include diabetes screening, hepatitis B screening, cervical dysplasia screening, lead screening, vision screening, breast cancer mammography screenings, human papilloma virus (HPV) DNA testing, and more. Many of these tests would only be considered preventive if the patient is considered at risk for developing one of these medical conditions based on their age, gender, lifestyle or other risk factors. Otherwise these tests might be considered diagnostic, in which case they would not be considered eligible for reimbursement under the classification of being a lab test (U.S. Food and Drug Administration).

Medical doctors will order the lab tests that incur lab fees. If a lab fee is part of the expense, it's because a test requires the use of laboratory technicians and equipment. Most tests to screen for medical conditions require the support of a medical testing laboratory. The most common type of medical appointments that entail lab fees include dermatology appointments, gynecology appointments, oncology appointments, neurology appointments, and prenatal appointments.

Because lab fees are part of visiting a medical doctor and receiving health care in a hospital or clinic, they do not require a prescription or Letter of Medical Necessity (LMN) in order to be considered eligible for reimbursement with a consumer-directed healthcare account.