/depts/,/depts/uwhealth/,/depts/uwhealth/benefits/,/depts/uwhealth/benefits/open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwmf-open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwmf-open-enrollment/flexible-spending-account-fsa/,/depts/uwhealth/benefits/open-enrollment/uwmf-open-enrollment/flexible-spending-account-fsa/resources/,

/depts/uwhealth/benefits/open-enrollment/uwmf-open-enrollment/flexible-spending-account-fsa/resources/Guide-to-Combination-FSAs.pdf

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Guide to Combination FSAs

Guide to Combination FSAs - Departments & Programs, UW Health, Benefits, UW Health Open Enrollment, UWMF Open Enrollment, Flexible Spending Account (FSA), Resources


Guide to Combination FSAs
www.DiscoveryBenefits.com
Revised 11/07/16
TAKE CARE OF
OUT-OF-POCKET
EXPENSES
A Combination FSA (also known as a Post-Deductible FSA) is a Limited Medical FSA plan that is converted to a general-purpose
Medical FSA once a participant has met the IRS statutory deductible.

2016 IRS Deductibles Single Coverage: $1,300 Family Coverage: $2,600
2017 IRS Deductibles Single Coverage: $1,300 Family Coverage: $2,600
• Combination FSA initial eligible expenses include dental, vision and preventive care.
• When participants meet the IRS deductible with out-of-pocket medical expenses, they must submit the Deductible Verification
Form to Discovery Benefits. This document serves as a one-time notification the deductible was met, and it is available on
the employer and consumer portals. Discovery Benefits does not require documentation for expenses used to reach the
deductible. Medical expenses used to meet the statutory deductible are not reimbursable with the Combination FSA. Funds in the
participant’s Health Savings Account can be used to meet the statutory deductible.
• Af�er the Deductible Verification Form is processed, Discovery Benefits accepts claims for medical expenses in addition to dental,
vision and preventive care claims. Note: For medical expenses to be eligible for reimbursement, the dates of service must be on or
af�er the date the statutory deductible was met.
• The debit card will only approve Limited Medical FSA expenses af�er the IRS deductible is met. Claims beyond dental, vision and
preventive care must be submitted manually or on the participant portal.
Please contact our Participant Services team if you have questions
about your benefits.

Toll Free: 866-451-3399 | Hours: M-F 6:00 am-9:00 pm CST
customerservice@discoverybenefits.com
Limited Medical FSA Eligible Expenses
Dental Vision Preventive
• Dental treatment • Vision correction procedures (e.g. Lasik) • Annual physicals
• Dental co-insurance/co-pays/deductible • Eye exams • Screenings (e.g. Lifeline)
• Cleanings • Prescription glasses and sunglasses • Tobacco cessation programs
• Fillings • Contact lenses • Obesity weight loss programs
• Crowns • Contact solutions/cleaning products • Immunizations
• Orthodontics • Vision screenings • Birth control
• Dentures • Refractions • Flu shots
• Denture adhesive and cleaners • Eye drops • Well child/prenatal visits
Eligible Medical Expenses Only Af�er Deductible is Met
• Medical co-insurance/
co-pays/deductible
• Medical expenses
• Mental health
expenses
• Chiropractic expenses