The IRS enables employers to offer an employee benefits plan with FSA , HRA and HSA accounts. These programs permit funds to be placed in an account that can be used to pay for health care expenses, such as co-pay amounts, prescriptions, and other eligible medical expenses. Additionally, an employer’s benefit plan administrator may offer a debit card to provide convenient access to FSA/HRA/HSA account funds. So, an FSA/HRA/HSA debit card is what is meant by the term health benefit card.While plan administrators determine the requirements for how FSA, HRA and HSA debit cards work, SIGIS offers two services that may be helpful to card holders. These are the Store Locator Service and the Eligible Product List Criteria publication.
The IRS determines what health care services and products are eligible for card holders to purchase with an FSA or HRA card. To help all SIGIS participants, SIGIS determines whether a product qualifies or does not qualify as a medical expense under IRS Code Section 213(d) and applicable IRS guidance.
Card holders may access and download a document that describes the criteria for an eligible product. This document explains health care items that are considered eligible or ineligible for purchases by FSA and HRA card holders. Health care items that are not eligible for purchase include both those that are dual-purpose or ineligible:
Over-the-counter products that treat a specific medical condition and are primarily for a medical purpose. They include medicines or products that diagnose, alleviate or treat existing or imminent injuries, illnesses or medical conditions. These drugs and products are not cosmetic in nature, or merely beneficial to general health or used for personal hygiene. As a general rule, most of these products are of short-term use, but some do treat chronic medical conditions.
These products may have both a medical purpose and a personal hygiene, cosmetic or general health purpose. In order to be considered eligible, they must be used to treat a medical condition and not used to improve or maintain general health unless prescribed by a physician to treat a specific illness, condition or injury. These products may be eligible for reimbursement, but require a letter of medical necessity from a licensed health care professional stating the specific diagnosis or medical condition, the specific over-the-counter medicine recommendation to treat the condition, and documentation of the product and cost. Dual-purpose items will not be included in the SIGIS List, but may be submitted to a plan administrator with the required documentation as noted above. Card holders should contact their plan administrator for more information and the documentation required.
Products that are used for general health, cosmetic, or personal hygiene purposes are not reimbursable. Typically, these are not referred to as medicines or drugs and are not recognized to treat a medical condition. Medical expenses that are not reimbursable under IRS Code Section 213(d) of the federal tax code are ineligible. These include food supplements, toiletries, lotions and soaps, shampoos, and most herbal supplements. These items are also not on the SIGIS List.Click here for the Eligible Product List Criteria publication.
IRS Announcement 2021-7 Eligible Product List Changes
On Friday March 26th the Internal Revenue Service issued Announcement 2021-7 clarifying that the purchase of personal protective equipment, such as masks, hand sanitizer and sanitizing wipes, for the primary purpose of preventing the spread of the Coronavirus Disease 2019 are treated as amounts paid for medical care under IRS Code §213(d) and therefore deductible pursuant to IRS rules.
CARES Act - Eligible Product List Changes
On Friday March 27th the Coronavirus Aid, Relief, and Economic Security Act or the CARES Act was signed into law. The bill included a change impacting the use of funds from HSA, HRA and FSA health benefit accounts. The bill reverses the prescription requirement for Over the Counter Drugs for reimbursement and also includes eligibility for menstrual care products.
SIGIS Updates Eligible Product List Criteria - January 2020
Over the last 18 months, the SIGIS Eligible Product List Committee has been working to clarify certain categories of products with various industry and regulatory experts.
SIGIS Informational Letter Request to IRS
On June 11, 2018, Outside Counsel for SIGIS sent a letter to the IRS requesting clarification on certain items that the SIGIS Eligible Product List Committee has under review to determine their eligibility.
SIGIS Launches Network Certification Process to Support Durbin
On April 4th the SIGIS Board of Directors ratified new standards and certification policies in support of the Dodd Frank Wall Street Reform Act's network routing requirements. The standards will allow industry participants to use the SIGIS's standards on PIN networks as an option in meeting the new regulatory requirements.
SIGIS Updates Eligible Product List Criteria April 2012
The Eligible Product List Criteria was updated with clarifications for the Breast Pumps / Breast Feeding Supplies, Contraceptives, Elastics / Athletic Treatments, and Eye Care categories.
SIGIS Updates Eligible Product List Criteria
SIGIS has revised the Eligible Product List Criteria Document to address changes related to sunscreen, durable medical equipment and healthcare services.
SIGIS Merchant Store Locator Now Available
The Store Locator is now available for FSA/HRA card holders on the SIGIS website. This tool will help consumers find IIAS Certified and/or 90% Registered merchants.