I don't think they can require you to use the debit card. I actually lost mine. Just pay for stuff the usual way and submit the receipt. Actually, point hog though I am, I would have used the cards anyway if I hadn't lost them. It's far easier to just use the debit card than to have to save the receipts, copy them, and submit them. Of course it depends also on how much you are running through your account. If it's a high-deductible HSA it could be thousands a year; I just have an FSA that I use for glasses, contact lenses, and prescriptions. (With my health plan, I don't even have to pay to go to the doctor.)