Question of the Month
Question: Is it true that the annual fees charged by concierge doctors are an ineligible medical expense for reimbursement from an HSA or FSA?
Answer: That is correct. Such “membership fees” are generally not considered qualified medical expenses, excepting certain rare circumstances (see the last sentence below).
An access fee can be a flat amount payment paid to a provider in addition or as a substitution to any qualified plan’s cost share), regardless of the frequency the provider wants paid, generally will not qualify as an eligible expense for reimbursement under a HSA and/or FSA Some perks offered for this flat amount generally will not qualify include fees for preferential “extras” (e.g., priority when scheduling appointments, 24-hour access to the doctor, less time in the waiting area before appointments, a special waiting room, etc.). Depending on how the underlying program is structured, some services might be reimbursable if presented as a requirement implicating the plan’s cost sharing features, such as member copays. In such instances, part or all of the fee might actually satisfy IRC Section 213(d), thereby qualifying for reimbursement on the basis of a qualifying and eligible individual healthcare related expense.
More Information
For questions regarding this Legislative Update or any other related compliance issues, please contact your Burnham Benefits Consultant or Burnham Benefits at 949‐833‐2983 or inquiries@burnhambenefits.com.
This Legislative Update was prepared by the Baldwin Regulatory Compliance Collaborative (the “BRCC”), a partnership of compliance professionals offering client support and compliance solutions for the benefit of the Baldwin Risk Partners organization, which includes: Jason Sheffield, BRP National Director of Compliance; Richard Asensio, Burnham Benefits Insurance Services; Nicole L. Fender, the Capital Group; Bill Freeman, AHT Insurance; Stephanie Hall, RBA/TBA; Caitlin Hillenbrand, AHT Insurance; Paul Van Brunt, Baldwin Krystyn Sherman Partners (BKS); and Natashia Wright, Insgroup.
Burnham Benefits and the BRCC do not engage in the practice of law and this publication should not be construed as the providing of legal advice or a legal opinion of any kind. The consulting advice we provide is intended solely to assist in assessing its compliance with applicable federal and state law requirements, and is based on our interpretation of federal guidance in effect as of the date of this publication. To the best of our knowledge, the information provided herein, and assumptions relied on, are reasonable and accurate as of the date of this publication. Furthermore, to ensure compliance with IRS Circular 230, any tax advice contained in this publication is not intended to be used, and cannot be used, for purposes of (i) avoiding penalties imposed under the United States Internal Revenue Code or (ii) promoting, marketing or recommending to another person any tax-related matter.