Letter of Medical
Necessity (LMN)

An LMN, or Letter of Medical Necessity, is like a doctor’s note. It’s issued by a healthcare provider to outline the medical reasons why a particular product or service is medically necessary for an individual's health, and qualifies your purchase to be HSA/FSA eligible. LMNs demonstrate that an expense is needed to diagnose, treat, or alleviate a medical symptom, rather than for general health or wellness purposes.

Certain products are eligible for purchase with HSA/FSA funds if they treat, cure, prevent, diagnose, or alleviate a medical need. For instance, items like bandaids are always eligible as they serve a solely medical purpose. However, there are “dual-eligible” products that can be used for general health and wellness or for specific medical purposes—if recommended by a healthcare provider based on your individual needs. Take iron supplements, for example; many use them to support their overall health. Yet, for someone with anemia, iron supplements become crucial. In such cases, individuals can use their HSA/FSA funds if their healthcare provider issues an LMN, recommending the supplements specifically to address their anemia.

You can request a Letter of Medical Necessity through Sika’s merchant partners on their website. If you’re approved, you’ll be able to check out using your HSA/FSA funds for your qualified purchase. Here’s how:

• 1. Fill out a quick survey to see if you prequalify for a Letter of Medical Necessity
• 2. Complete the intake form to tell Sika’s provider team about your qualifying symptom(s), similar to how you would at a doctor’s office
• 3. Our team of healthcare providers will evaluate your qualifying symptom(s) and determine your eligibility

Once you have your LMN in hand, you can return to the merchant’s site and shop as usual. During checkout, you’ll simply select the Sika payment method to utilize your HSA/FSA funds.

Our merchant Our healthcare provider team strives to provide a response within 12 business hours after you submit your LMN intake forms.

To see if you’re a candidate for a Letter of Medical Necessity, similar to other telehealth experiences, you’ll be asked to share your name, contact information, date of birth, and information about the symptoms you are experiencing and your medical history. We will also verify your phone number and ask you to upload a photo ID to verify your identity.
The information you provide in the LMN process will be kept confidential and shared only with our independent healthcare provider(s) to evaluate your eligibility for an LMN. For more information, see our privacy policy.

Letters of Medical Necessity are valid for 12 months from the date they are signed.
Please note, LMNs cannot be used retroactively for purchases made prior to the date they are signed.

After you complete a purchase using an LMN, you will need to submit your Letter of Medical Necessity and your receipt to substantiate the purchase if you paid with your HSA/FSA or to get reimbursed if you paid with your credit/debit card. To do this:

• 1. Log into your HSA/FSA account on your benefit administrator’s website
• 2. Find the Reimbursement or Claims section
• 3. Upload your receipt and Letter of Medical Necessity

Your administrator will process and evaluate your claim. Please note that some HSA/FSA benefits administrators may incorrectly deny reimbursement, so before purchasing a product with an LMN you should consider contacting your administrator to determine if your purchases will be covered/reimbursed. You can learn more about what is eligible at https://www.irs.gov/publications/p969.
If you are having trouble locating your itemized receipt or LMN, please contact Sika at support@sikahealth.com

Sika’s independent healthcare provider may determine that you do not have symptoms demonstrating a medical necessity for a product or service. While you cannot use your HSA/FSA funds now, you can still use another payment method to complete your purchase. We do not recommend reapplying.