A HealthEquity Letter of Medical Necessity is a short form your doctor signs to confirm that a specific expense treats a diagnosed medical condition, which is what makes it reimbursable from your FSA, limited-purpose FSA, or HRA. You download the form from HealthEquity, fill in the account holder section yourself, have your provider complete the diagnosis and treatment section with specifics, and submit the signed form through the member portal, the mobile app, fax, or mail. The form is titled “HRA/FSA Letter of Medical Necessity” on HealthEquity’s materials.1HealthEquity. HRA/FSA Letter of Medical Necessity
When You Actually Need One
Routine medical costs like prescriptions, office visits, and lab work don’t need an LMN. The form exists for expenses that sit on the line between medical treatment and general wellness. IRS Publication 502 limits deductible medical care to expenses that alleviate or prevent a physical or mental disability or illness, which is why borderline items need a provider to tie them to a diagnosis.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
Expenses that commonly require an LMN before HealthEquity will reimburse them:
- Weight-loss program fees, which qualify only when a physician has diagnosed a specific disease such as obesity, hypertension, or heart disease. Diet food itself doesn’t qualify.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
- Nutritional supplements and vitamins, eligible only when a medical practitioner recommends them to treat a specific diagnosed condition.2Internal Revenue Service. Publication 502 – Medical and Dental Expenses
- Exercise equipment prescribed for a diagnosed cardiovascular condition, as opposed to general fitness.
- Massage therapy for a diagnosed condition like chronic pain or a musculoskeletal disorder.
- Orthotics or specialized footwear prescribed for a diagnosed foot or back condition.
Where To Get the Form
HealthEquity hosts the PDF on its account forms page, and it’s also available inside the member portal under forms or documents.3HealthEquity. Account Forms Print it and bring it to your appointment, or email it to the office in advance so your provider has it ready.
Filling In the Account Holder Section
The top of the form is your responsibility. Enter your employer’s company name, the last four digits of your Social Security number or your HealthEquity ID, your full name, mailing address, email address, and daytime phone number. The email field is marked required. If the person receiving treatment is a dependent, put your information in the account holder fields and the dependent’s name in the patient field.1HealthEquity. HRA/FSA Letter of Medical Necessity
What Your Provider Needs To Write
Most rejections happen in the diagnosis and treatment section. The form asks four questions, and vague answers on any of them can sink the whole submission.
Diagnosed Medical Condition
Your provider has to name the specific condition. “General wellness” or “stress” is not enough. A diagnosis like “chronic lumbar radiculopathy” or “clinical obesity” gives the reviewer a clear medical basis.
Recommended Treatment
The treatment must be described exactly. For supplements, herbs, or equipment, the form requires each item listed by specific name.1HealthEquity. HRA/FSA Letter of Medical Necessity “Vitamins” will not pass. “Vitamin D3, 5000 IU daily” will.
How the Treatment Alleviates the Condition
A sentence or two connecting the treatment to the diagnosis. This is where the provider explains the medical logic, so the reviewer can see why this specific treatment addresses this specific condition.
Treatment Time Period
A start date and an end date. The period cannot exceed 12 months, and open-ended recommendations are not accepted. If the treatment continues past the end date, you submit a new form for the next period.1HealthEquity. HRA/FSA Letter of Medical Necessity
Provider Signature and License
Your doctor prints their name, signs, dates the form, and enters their provider license number, phone number, and office address.1HealthEquity. HRA/FSA Letter of Medical Necessity The form uses the word “physician,” but the instructions at the top accept any licensed healthcare provider. A missing signature or missing license number triggers an automatic rejection.
Some practices charge an administrative fee to complete the form, and that fee is generally not reimbursable from your FSA or HRA. Ask the office in advance if cost is a concern.
Submitting the Signed Form
You have four ways to send the completed form to HealthEquity:
- Upload it through the HealthEquity member portal.
- Scan or photograph it and upload through the HealthEquity mobile app.
- Fax it to 520-844-7090.4HealthEquity. Move It. Double It
- Mail it to HealthEquity, Attn: Client Services, PO Box 14374, Lexington, KY 40512.4HealthEquity. Move It. Double It
The portal and app are the fastest. Keep a copy of the signed form before you send it, regardless of channel.
How Long Review Takes and How Long Approval Lasts
HealthEquity processes FSA and HRA reimbursement claims within three to five business days of submission.5HealthEquity. Member Reimbursement Processing Times LMN reviews may follow a similar window, though HealthEquity does not publish a separate timeline specifically for LMN approvals. You’ll be notified through your preferred communication method once the form is approved or if more information is needed.
An approved LMN covers the treatment period on the form, up to 12 months. Recurring expenses within that window, like monthly therapy sessions, don’t need a new form each visit. Once the end date passes, submit a fresh LMN to continue using tax-advantaged funds for the same treatment. Approvals cannot be indefinite.1HealthEquity. HRA/FSA Letter of Medical Necessity
If HealthEquity Rejects the Form
The most common reasons for rejection are blank fields, vague diagnosis descriptions, and missing provider signatures. Check the form for mechanical errors before assuming the expense itself doesn’t qualify, since a corrected resubmission often resolves the issue.
If HealthEquity determines the expense doesn’t qualify even with a completed form, ask for a written explanation of the denial. You can then work with your provider on a more detailed letter that directly addresses why the treatment is medically necessary for your condition. Having the provider explain the clinical reasoning in depth, rather than restating the diagnosis, makes a stronger case on the second submission.
Records To Keep
Hold onto the signed LMN, the approval notice, and related receipts for at least three years after you file the tax return that includes the reimbursed expense. That window matches the standard IRS statute of limitations for assessing additional tax.6Internal Revenue Service. How Long Should I Keep Records A digital scan filed with your tax documents is the simplest way to have what you need if the IRS asks questions about a distribution.