Citi Benefits Handbook
Rules and Features
You can contribute between $120 and $2,550 a year on a before-tax basis to reimburse yourself for eligible out-of-pocket dental, vision, and preventive care medical expenses. Contributions are taken each pay period before federal and, in most locations, state and local taxes are withheld.
The $2,550 limit applies to each employee electing to participate in the LPSA. If you and your spouse/partner are both Citi employees, you can each contribute up to $2,550 to your LPSA.
Because the LPSA is intended to be used in conjunction with a HDHP/Health Savings Account (HSA), eligible expenses are limited to dental, vision, and preventive care medical expenses that are not already covered. Other medical care expenses should be paid from your Health Savings Account (HSA). Be sure to save your receipts in case you are required at a later date to substantiate that your expense was eligible for reimbursement under the Plan.
OTC Drugs, Medicines and Biologicals
You may be reimbursed for over-the-counter medicines and biologicals through your LPSA only in instances when a physician has prescribed the medicine or biologicals or if the medicine is insulin.
Examples of Eligible Health Care Expenses
  • Your share of expenses that are not paid by your dental and/or vision plan, such as deductibles, coinsurance, and copayments and charges that exceed maximum allowed amounts or other plan limits;
  • Vision care expenses, such as exams, prescription eyeglasses and sunglasses, prescription contact lenses, and laser surgery, which are not covered by your medical or vision plan;
  • Preventive care medical expenses not already covered by the Plan; and
  • Screening services including routine cancer, heart disease, and infectious disease screening.
Because network preventive care is covered at 100% in the HDHP, you will not need this account to reimburse yourself for network preventive medical care expenses. However, if you obtain preventive care from an out-of-network doctor, the HDHP will cover 100% of maximum allowed amount only. As a result, not all preventive care charges may be covered.
Examples of Ineligible Health Care Expenses
  • Expenses for which you have been reimbursed from another source, such as Citi's or another employer's medical, dental, and/or vision plan, Medicare, Medicaid, or your HSA;
  • Non-preventive care medical expenses;
  • Elective cosmetic surgery or cosmetic dental work;
  • Vitamins or minerals taken for general health purposes, including those recommended by your physician;
  • Maternity clothes or diaper services;
  • Nursing services to care for a healthy newborn;
  • Household help or custodial care at home or in an institution, even if recommended by your physician;
  • Health club fees, exercise classes, or weight-loss programs for general health purposes, even if recommended by your physician;
  • Cosmetics, toiletries, or toothpaste;
  • Amounts you pay for medical and dental insurance premiums; and
  • Long-term care services including insurance premiums for long-term care insurance.
For More Information
For more information about eligible expenses, see IRS Publication 502: Medical and Dental Expenses at www.irs.gov or contact your tax adviser. You also can call the IRS at 1 (800) 829-1040.
Note: The IRS publication is a guideline for use in preparing tax returns; it is not a description of the Citi Plan.
Is the LPSA for You?
The LPSA is for employees who enroll in the HDHP.
Generally, employees who enroll in the HDHP and establish an HSA can also enroll in an LPSA to pay for eligible health care expenses with before-tax dollars. ("Establish" an account means you apply for an account, which is approved because you meet certain credit and customer identity validation requirements. If your account is not established, you cannot receive the employer contribution.) However, you may enroll in an LPSA even if you are not enrolled in an HSA (as long as you are enrolled in the HDHP).
Note: Employees who enroll in the High Deductible Health Plan generally are not eligible to enroll in an HCSA.
Plan Your LPSA Contributions Accordingly
Because network preventive care is covered at 100% in the HDHP, you will not need this account to reimburse yourself for network preventive medical care expenses. However, if you obtain preventive care from an out-of-network physician, the HDHP will cover 100% of maximum allowed amount only. As a result, not all preventive care charges may be covered.
To participate in the LPSA each plan year, you must actively enroll. Your enrollment does not carry over from year to year.
You can be reimbursed for expenses incurred only during the time you are enrolled. The amount of your payroll contributions will appear on your Form W-2 Wage and Tax Statement for the year in which you were enrolled. Be sure to save your receipts in case you are required at a later date to substantiate that your expense was eligible for reimbursement under the Plan.
In accordance with IRS guidelines, the Plan Administrator, in its discretion, may reduce the rate of contribution by certain participants to ensure that the LPSA is not deemed to discriminate in favor of highly compensated employees.