Dobbs decision: How HSAs, FSAs, and related benefits support reproductive healthcare

Editor’s note: This information was published on July 15, 2022.

With recent news about changes to healthcare related to pregnancy, you likely have questions about your healthcare spending account benefits. We can help.

What happened?

On June 24, 2022, the United States Supreme Court (SCOTUS) released a decision or ruling in a case called Dobbs v. Jackson Women’s Health (Dobbs). In the simplest terms, this ruling means that how people access legal abortions is now decided state-by-state and not at the federal level.

While the recent ruling specifically talked about abortion access, it increased attention on all kinds of reproductive health benefits. If you’re curious about how your benefits cover family planning services—eligible medical travel expenses, birth control, pregnancy, childbirth—we have answers to help you.

What does this mean for reproductive health and family planning coverage?

Accounts that cover family planning services are: Health Savings Accounts (HSAs), health Flexible Spending Accounts (FSAs), and Health Reimbursement Arrangements (HRAs). Lifestyle Spending Accounts (LSAs) may also be used too.

In general, the Dobbs case doesn’t change what you can buy (eligible medical expenses) with your HSA, FSA, or HRA. And, in general, it doesn’t change what types of receipts and records you need to submit (what we call documentation requirements). For example, you can still get reimbursed for medical travel and lodging with those accounts. If you have an LSA, read the details closely because those accounts are unique to each employer.

There are several ways pre-tax benefits like HSAs support you for reproductive health and family planning. Most of these benefits have been available for some time and will likely continue to be available to you. It’s always a good idea to confirm your specific plan rules with your benefits team.

How do I know what’s covered?

The best place to start is with our searchable database on qualified medical expenses. From fertility treatments and birthing classes to birth control and medical travel—you can see what’s covered by account type.

And be sure to read the summary plan description (SPD) that your employer gives to you. The SPD is a detailed guide that spells out your benefits and how the plan works.

Other helpful resources are the HSA Store¹ and FSA Store²—online sites where you can purchase products and read about eligibility rules for the items you want to buy.

What are the specific rules for HSA, FSA, HRA, and LSA?

We know there are a lot of details. Find your account type in the sections below and then look to see what’s covered and how.

• Health Savings Account (HSA)
• Healthcare Flexible Spending Account (FSA)
• Health Reimbursement Arrangement (HRA)
• Lifestyle Spending Account (LSA)

You can also jump straight to the end for additional resources and links.

Details on coverage by account and related topics

Health Savings Account (HSA)

With an HSA, legal abortions and medical travel are still considered an eligible and reimbursable expense and are tax-free. There are many other reproductive health services covered by an HSA. HSA coverage cannot be restricted by an employer, so you’re free to use HSA dollars on any eligible expense per the IRS.

Expenses covered

Contraceptives that require a prescription (birth control pills and patches, intrauterine devices (IUDs), diaphragms), condoms, vasectomy (and reversal), pregnancy tests, legal abortions (including abortion pills), medical travel (transportation and lodging), ovulation and fertility monitors, in vitro fertilization (IVF) and other fertility procedures (letters of medical necessity may be required for items such as egg and embryo storage fees), cord blood storage (with a letter of medical necessity), OB/GYN visits (obstetrical care), midwife treatment, prenatal vitamins, birthing coach and doula (with letter of medical necessity), lactation aids and consultants, breastfeeding classes, breast pumps and nursing supplies (breast milk storage bottles or bags, lanolin, etc.), and hospital bills for childbirth. The list of eligible expenses includes everything from tampons to newborn care, so be sure to check for your specific medical expense on the list of HSA qualified medical expenses (QME).

Limits

Transportation primarily for and essential to medical care. 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. There are no limits for the medical expenses themselves beyond what is in your HSA.

Lodging reimbursement is limited to $50 per night and 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. If a parent is traveling with a sick child, up to $100 may qualify ($50 for each person).

Note that you must be enrolled in a qualifying high-deductible health plan to have an HSA and cannot be also enrolled in a full-purpose FSA or HRA or have any additional impermissible coverage.

Documentation requirements

You’re responsible for maintaining appropriate documentation in case of an audit.

Healthcare Flexible Spending Account (FSA)

With an FSA, legal abortions and travel are still considered an eligible and reimbursable expense and are tax-free. However, some FSAs are designed to be more limited when it comes to eligible expenses. Always refer to your plan details for the most-up to date information. Here are some things to consider.

Expenses covered

Eligible expenses are the same as for HSAs (see above).

Limits

The specific limits on transportation and lodging are the same as for HSAs (see above).

Documentation requirements

You’ll need to supply documentation from an independent third party describing who the service is for, the type of 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 medical procedure itself to prove that the travel was for a medical expense. This is the same requirements for HRAs (see below).

Health Reimbursement Arrangement (HRA)

With an HRA, legal abortions and travel are still considered an eligible and reimbursable expense and are tax-free. However, HRA coverage can be restricted by an employer, so it’s important to reach out to your benefits team if you have specific coverage questions. Note that you and eligible dependents must be enrolled in an Affordable Care Act (ACA)-compliant group health plan. Here are some things to consider.

Expenses covered

Eligible expenses are the same as for HSAs (see above).

Limits

The specific limits on transportation and lodging are the same as for HSAs (see above).

Documentation requirements

Documentation requirements are the same as for FSAs (see above).

Lifestyle Spending Account (LSA)

With an LSA, your employer can provide taxable reimbursements, including legal abortions and medical travel. LSAs can be created for adoption, fertility treatments, and surrogacy. In fact, 21 percent of our lifestyle spending accounts (LSAs) offer some kind of family planning or reproductive health benefit. Some employers create LSAs to supplement the coverage from an HSA, FSA, or HRA. Because every LSA is unique and customized to the employer’s specification—expenses covered, limits, documentation requirements—it’s important to reach out to your benefits team for the details.

Stay tuned

At our core, we’re committed to helping you stay informed, especially as it relates to what services you can access for pregnancy and more. Our teams are here to help. We’re following what’s happening closely. As news and policy change daily, check back often for updates. For additional employer-focused information, visit: Using workplace benefits to support reproductive health and family planning.