HSA/FSA PAYMENT FOR SERVICES

Our HSA/FSA Designation is: 8099

HSA/FSA Payment Explanation for ELYSARA

At ELYSARA, many of our services may be eligible for payment using Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA). The information below explains how these accounts work, what is typically eligible, and what documentation you may need to provide to your plan administrator.

What Are HSA and FSA Accounts?

- HSA (Health Savings Account): A tax-advantaged savings account available to individuals with a high-deductible health plan (HDHP). Funds roll over yearly and can be used for qualified medical expenses.
- FSA (Flexible Spending Account): An employer-sponsored account funded with pre-tax dollars to pay for qualified medical expenses. Most FSAs expire annually unless a rollover or grace period is offered.

Both can be used to cover qualifying out-of-pocket healthcare expenses.

Are ELYSARA Services Eligible for HSA/FSA Reimbursement?

Because eligibility depends on IRS rules and your specific plan:

Typically Eligible:

Medical services that diagnose, treat, or prevent a medical condition may be HSA/FSA eligible when medically necessary. These may include:
- Medical evaluations
- Laboratory testing

- Our IV treatments are usually eligible if they are prescribed by a medical practitioner with a valid prescription
- Certain wellness therapies when ordered for a clinical indication
- Medically necessary treatments or procedures documented by a provider

A Letter of Medical Necessity (LMN) may be required for some services.

Not Always Eligible:

Some services fall under “non-medical cosmetic, elective, or luxury wellness,” which are often not HSA/FSA eligible, including:
- Cosmetic treatments performed solely for appearance
- Aesthetic enhancements not tied to a medical diagnosis
- General wellness or elective services without a documented medical necessity

Your plan administrator determines final eligibility—not ELYSARA.

Payment Process at Elysara

- ELYSARA does not bill HSA/FSA administrators directly.
- Patients may:
• Use their HSA/FSA card at the time of payment if the card is approved, or
• Pay out-of-pocket and submit receipts to their plan for reimbursement.

Receipts & Documentation

ELYSARA will provide:
- An itemized receipt
- Diagnosis codes (when applicable)
- Procedure/service descriptions

If your administrator requires a Letter of Medical Necessity, your provider may complete one if clinically appropriate.

Important Notes

- Eligibility varies by plan and is ultimately determined by your HSA/FSA administrator, not ELYSARA.
- If your plan denies reimbursement, ELYSARA cannot alter service descriptions or retroactively classify services as medically necessary.
- Patients are financially responsible for all charges regardless of insurance or HSA/FSA reimbursement outcomes.

Questions?

We are happy to guide you on what documentation we can provide. For specific eligibility rules, please contact your HSA/FSA plan directly.