Only available to participants enrolled in a High Deductible Health Plan (HDHP).
A Limited Purpose Flexible Spending Account (LPFSA) is a pre-tax benefit used to pay for eligible dental, vision care, and post-deductible medical expenses. You may use these funds to pay for eligible expenses incurred by you, your spouse, and your qualified dependents.
Plan Year
2025
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
File a copy of this form with each of your former retirement systems each time you become covered under a new retirement system, for limited reciprocity between the three public employee retirement systems in Wisconsin.