Forma may request additional information, such as an Explanation of Benefits (EOB) or a Letter of Medical Necessity (LMN), when required to verify that a product or service is eligible for reimbursement when you submit a pre-tax claim.
Explanation of Benefits (EOB)
All Health FSA and HRA claims must include proof from an independent third-party to verify that the expense qualifies as a medical expense under the law and plan guidelines. An Explanation of Benefits (EOB) is one type of acceptable documentation, though an itemized statement from the provider or other documentation can also fulfill this requirement. The documentation must include:
- Name of the expense
- Date of the expense
- Amount of the expense
- Name of the person who incurred the expense
This information is required for all claims, except for card transactions that automatically adjudicate. Credit card receipts and similar documentation is generally not sufficient because it does not include all elements required for substantiation.
In certain situations, you must submit an Explanation of Benefits (EOB) for reimbursement. This typically applies to post-deductible HRA enrollees also contributing to an HSA. To maintain HSA eligibility, HRA coverage cannot begin until you’ve met the minimum HSA deductible. The EOB serves as proof that the deductible has been met, allowing the post-deductible HRA to reimburse expenses.You will be asked to provide an EOB in these cases. Insurance companies provide EOBs anytime you incur a medical expense covered under the group health plan. They are generally sent in the mail and also available in your online medical insurance portal.
Letter of Medical Necessity (LMN)
For certain “dual-purpose” expenses—such as supplements, gym memberships, or cosmetic procedures, additional documentation may be required. To see a full list of pre-tax categories that require a Letter of Medical Necessity (LMN), log in to your Forma account and navigate to Benefits > [your pre-tax account] > What’s Eligible? Categories requiring an LMN are marked with an asterisk (*).
Since these can be used for both personal and medical reasons, you’ll be asked to submit the usual documentation plus a Letter of Medical Necessity (LMN) from your healthcare provider. The LMN confirms that the expense is medically necessary to treat a specific condition. Keep in mind: even if your card transaction goes through automatically, dual-purpose expenses may still require extra documentation after the fact.
An LMN confirms that:
A licensed medical professional has diagnosed you with a specific condition
They’ve recommended the item or service as part of your treatment
The item or service directly supports the management or treatment of that condition
Think of the LMN as a note from your provider explaining why the expense is medically necessary for you.
If an LMN is required, request a note from your medical practitioner that recommends the dual-purpose item/service to treat a specific medical condition with which you have been diagnosed. The practitioner can use their own form or can complete Forma’s LMN Template.