You can contribute between $120 and $3,200 per year on a before-tax basis to reimburse yourself for eligible out-of-pocket dental, vision and preventive care medical expenses. Contributions are deducted each pay period before federal and, in most locations, state and local taxes are withheld.

The $3,200 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 $3,200 to your LPSA.

Because the LPSA is intended to be used in conjunction with a High Deductible Plan with 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.

Expenses for over-the-counter drugs and medicine without a prescription are permitted to be reimbursed under the HCSA and LPSA.

Because network preventive care is covered at 100% in the High Deductible Plan with HSA, 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 High Deductible Plan with HSA will cover 100% of the maximum allowed amount only. As a result, not all preventive care charges may be covered.

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.

The LPSA is for employees who enroll in the High Deductible Plan with HSA.

Generally, employees who enroll in the High Deductible Plan with HSA 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 High Deductible Plan with HSA).

Note: Employees who enroll in the High Deductible Plan with HSA generally are not eligible to enroll in an HCSA.

Because network preventive care is covered at 100% in the High Deductible Plan with HSA, 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 High Deductible Plan with HSA will cover 100% of the 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 expenses were 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.