— STEP III · PAYMENT METHOD —

How would you like to pay?

HSA Card

Health Savings Account — pre-tax dollars from your HDHP plan.

— Save up to 30% —

FSA Card

Flexible Spending Account — pre-tax payroll deductions.

— Save up to 30% —

Credit / Debit

Standard Visa, MasterCard, American Express, Discover.

Apple Pay

Tap to complete — single-touch checkout with Face ID.

— THE HSA VERIFICATION · FOUR STEPS —

✓

I · Eligibility audit

— Complete —

We have audited each item in your bag against IRS Publication 502. Your cart contains both fully-eligible items and one cosmetic item — they will be split automatically at payment.

— Item —

— Category —

— Amount —

The Whitening Atelier · with LMN

HSA Eligible

$285

The Sonic Brush · with LMN

HSA Eligible

$165

The Travel Companion · cosmetic

Standard Pay

$58

Eligible portion: $450 · Standard portion: $58 — both will be charged in this transaction.

II · HSA card details

— Active —

Enter your HSA debit card exactly as it appears. Our system, powered by Sika Health, will validate the BIN (Bank Identification Number) against the registry of HSA / FSA issuers.

— Card Number —

— Name on Card —

— Expiry —

— CVV —

HSA · Verified — Card issued by HealthEquity · BIN 474411 confirmed in HSA registry —

III

III · Sika Health processes eligible portion

— Pending —

Our payment partner Sika Health processes the $450 eligible portion under the dental merchant category code (MCC 8021). Your HSA card is charged. The transaction is itemised, IRS-formatted, and stored in your account.

IV · Standard payment for cosmetic portion

— Pending —

The remaining $58 (cosmetic item) will be charged to a backup payment method via Stripe. Add a card now, or use Apple Pay at the next screen.

— Backup Card (Visa / MC / Amex) —

— Or use Apple Pay at the review step.

← Continue Shopping Continue to Review · Step IV →

I Shopify commerce engine — PCI-compliant, in your practice's name

II Stripe Radar fraud protection on every credit card transaction

III HSA / FSA verified via Sika Health · IRS-compliant receipts

IV Letter of Medical Necessity included where required

— The Architecture Behind This Checkout —

Your storefront runs on three trusted platforms — Shopify for ecommerce, Stripe for credit cards, Sika Health for HSA & FSA. All accounts are in the practice's name, on the practice's card. Maison Dental Co. designs and operates the storefront — the practice owns the business.

— Your Order —

The Whitening Atelier

— Qty 1 · 14-day protocol —

— HSA Eligible · with LMN —

$285

The Sonic Brush

— Qty 1 · Five-mode —

— HSA Eligible · with LMN —

$165

III

The Travel Companion

— Qty 1 · Cosmetic kit —

— Standard payment —

$58

— Subtotal — $508

— Delivery (complimentary) — $0

— Estimated tax — $31

— HSA tax savings (24% + 6% state) — − $135

— True cost — $404

— You Save —

$135

using your HSA card vs. after-tax dollars

— Processed Securely Via —

SHOPIFY STRIPE SIKA · HEALTH