Using workplace benefits to support reproductive health and family planning

Discover how tax-advantaged accounts like HSAs, FSAs, and HRAs provide resources and options to help people navigate complexity and take control of their healthcare.

Options. Control. Confidence.

The evolving legal landscape around reproductive healthcare is prompting many businesses to reevaluate their workplace benefits. Among other things, employees may need resources for:

  • Reproductive healthcare, including feminine care products
  • Infertility, adoption, and surrogacy
  • Out-of-state travel for healthcare services
  • Prenatal care and childbirth, including doula services
  • Post-partum mental health and lactation challenges

Group of Ladies

Pre-tax benefits like Health Savings Accounts (HSA), healthcare Flexible Spending Accounts (FSA), and Health Reimbursement Arrangements (HRA) already support many of these. In addition, businesses may choose to offer post-tax reimbursement for expenses not eligible under these accounts through a Lifestyle Spending Account (LSA).

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Dobbs decision: How HSAs and FSAs support reproductive healthcare

Reproductive health policy is changing. Here’s what we know so far about what is covered through your HSA, eligible travel expenses, and more. Get the details.

Find answers to common questions about reproductive healthcare and popular benefits accounts. We’ll continue to update as laws and regulations change.

Can members use an HSA, FSA, or HRA to pay for transportation for healthcare services?

Yes. You may use these accounts to pay for transportation primarily for (and essential to) medical care. This includes car and rental car expenses; bus, taxi, rideshare, train, plane, and ferry fares; and ambulance services. Rental car expenses are limited to the portion attributable to the medical appointment or other care. Instead of actual car expenses, a standard mileage rate (18 cents per mile for January 1, 2022–June 30, 2022, and 22 cents per mile beginning July 1, 2022) for use of a car to obtain medical care is allowed. Parking fees and tolls can also qualify.

Can members use an HSA, FSA, or HRA to pay for the lodging associated with travel for healthcare services? 

Yes. Up to $50 per night will qualify if these conditions are met: (1) The lodging is primarily for and essential to medical care; (2) the medical care is provided by a physician in a licensed hospital or medical care facility related to (or equivalent to) a licensed hospital; (3) the lodging isn't lavish or extravagant; and (4) there is no significant element of personal pleasure, recreation, or vacation in the travel.

Can members use an HSA, FSA, or HRA to pay for the lodging of a travel companion? 

Yes. These accounts will qualify for reimbursement if accompanying a patient for medical travel. For example, if a parent is traveling with a sick child, up to $100 per night ($50 for each person) will qualify.

What kind of documentation is required? 

For FSA and HRA, members will need documentation from an independent third party describing the service, the date of the service, and the amount of the expense. This would apply to the travel expense (e.g., a plane ticket, lodging receipt, etc.) as well as the service itself to prove that the travel was for a qualified medical expense.

For HSA, members are responsible for maintaining appropriate documentation in case of an audit.

Can I restrict medical travel expenses under my plan? 

It depends. Employers can restrict eligible expenses under an FSA, HRA, or an LSA. Under an HSA, expenses (including travel related to medical care) cannot be restricted. 

What if my state prohibits comprehensive reproductive health benefits? 

Due to the complexity and evolving legal landscape, employers in this situation should consult qualified legal counsel.

How does the Dobbs v. Jackson Women’s Health decision impact spending accounts? 

The Dobbs v. Jackson Women’s Health decision does not generally impact spending accounts administered by HealthEquity. We will provide updates if that changes in the future. 

Can I offer additional reimbursement for travel expenses?  

Yes. If you wish to increase reimbursement amounts or want to offer reimbursement to specific employee populations, an LSA may be a good option. With an LSA you can cover any travel benefits (not just medical travel) for all employees. There are no IRS caps on reimbursement amounts or mileage rates. You set your own limits. In this case, travel expenses would be reimbursed on a post-tax basis.

Will covering medical travel under an FSA, HRA, or LSA impact HSA-eligibility?

It depends. Participation in a general-purpose healthcare FSA and/or an HRA impact eligibility to make HSA contributions. By contrast, a post-deductible or limited-purpose FSA or post-deductible HRA will not impact eligibility to make HSA contributions. It is important to note depending on the LSA plan design, HSA eligibility could be impacted.  

Do ERISA, ACA, and COBRA regulations impact LSA plans?

It depends. An LSA that does not reimburse medical expenses is generally not considered a group health plan and is therefore not subject to Employee Retirement Income Security Act (ERISA), Affordable Care Act (ACA), or COBRA regulations. If you plan to reimburse medical expenses, then we encourage you to consult your legal counsel.

Are there any privacy protections for reproductive health benefits offered through an LSA?

Depending on your LSA plan design, Health Insurance Portability and Affordability (HIPAA) considerations may apply. For example, HIPAA considerations may apply for employers who obtain individually identifiable medical information.  

Have more questions? Contact us.

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