Limited Purpose FSA

2021 and 2022 Plan Year Information

What is a Limited Purpose Flexible Spending Account (FSA)?

If you’re enrolled in Option C under the Medical Plan, you may open a Limited Purpose Flexible Spending Account (LPFSA) to put aside before-tax money to pay for eligible dental and vision expenses (Note: Funds may not be used to pay for medical expenses). The Limited Purpose FSA is administered by Your Spending Account (YSA).

Who’s Eligible

All U.S. benefits-eligible employees enrolled in Medical Plan Option C.

Eligible Expenses

Use your Limited Purpose FSA to pay deductibles, copays and coinsurance related to dental and vision expenses only. Other eligible health care expenses include eyeglasses, laser eye surgery and orthodontia. For a complete list, see IRS Publication 502.

How It Works


Choose your contribution amount when you enroll.

In 2021, you can contribute up to $2,750, the IRS annual maximum. You can make changes during the year only if you experience a qualifying life event.

The money will be deducted from your paychecks in equal amounts throughout the year before taxes are calculated.


Use the Smart Your Savings Account (YSA) debit card to pay at the time of service or purchase, like you would use a debit or credit card. With the YSA debit card, you don’t have to fill out forms or wait for reimbursements. Eligible expenses will automatically be debited from your account.


Your eligible expenses must be incurred by December 31, 2021, and submitted for reimbursement by April 30, 2022. See below regarding unused 2021 LPFSA funds.

Roll Over

Any unused 2021 funds will roll over into 2022 if you elect to participate in a 2022 Limited Purpose FSA. The rollover funds must be used by December 31, 2022, or they will be forfeited back to the Plan.

Rollovers of unused amounts are not expected to be permitted after the rollover of 2021 amounts into 2022.