I had an FSA before moving to our high-deductible plan with HSA account. For the FSA they were required to have proof for every expenditure by the IRS regardless of how obvious an allowed expense. I certainly prefer the HSA account over the FSA, though moving to the CDHP plan itself certainly took some adjusting that first year. All preventative services are covered however, not just one. I've never heard of that NY Biker, so sorry to hear they've been able to get away with that. In the end, for us, they made our CDHP more attractive financially to us than the traditional HMO.