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Eligible Expenses Juke Box

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Services and Expenses Eligible for Reimbursement Under the FSAFEDS Program

For the FSAFEDS HCFSA and LEX HCFSA, services listed in this document as eligible (or that meet the "potentially eligible" requirements) are eligible for reimbursement, if the services are:

  • rendered by a health care professional appropriately licensed or certified in the state in which he or she practices; and
  • performed within the scope of the health care professional's license.

For the FSAFEDS DCFSA, services listed in this document as eligible (or that meet the "potentially eligible" requirements) are eligible for reimbursement, if the services are:

  • for an individual you claim as a dependent on your Federal Tax return who is under 13 or incapable of self-care; and
  • necessary to allow you and your spouse, if married, to work, look for work or attend school full-time.

*Please note, all "potentially eligible expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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A Print this Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
ACNE TREATMENT HCFSA X     Over-the-counter acne treatment products are eligible for reimbursement as long as the product’s primary purpose is for the treatment of acne. Cosmetics or other items that merely contain acne-fighting ingredients are not eligible. Eligible examples include:
  • Acne Free
  • Acnomel
  • Ambi Even & Clear
  • Bye Bye Blemish
  • Clean & Clear
  • Clearasil
  • Murad Acne Complex Kit
  • Nature's Cure Acne Treatment
  • Neutrogena Acne Treatment
  • OXY
  • Proactiv Solution
  • Stri-Dex
  • ZAPZYT Acne Treatment
  • Zeno Acne Clearing Device
Note: Generic and store brand equivalents of name brand acne treatments are also eligible. See the OTC Quick Reference Guide for more information.
ACUPUNCTURE HCFSA X      
ADAPTIVE EQUIPMENT HCFSA   X   Adaptive equipment for a major disability, such as a spinal cord injury, can be reimbursed.

Adaptive equipment to assist you with activities of daily living (ADL) for persons with arthritis, lupus, fibromyalgia, etc., can be reimbursed.

ADOPTION FEES HCFSA     X Medical expenses incurred by your adopted child who is claimed as a dependent are eligible. Care must be for the adopted child and incurred while the child qualifies as your dependent. Your child's medical care expenses are eligible only during the adoption process as long as the child qualifies as your dependent.
AIR CONDITIONERS/AIR PURIFIERS HCFSA   X   See ALLERGY PRODUCTS
ALCOHOLISM/DRUG/SUBSTANCE ABUSE TREATMENT HCFSA X     Eligible expenses include:
  • Inpatient treatment, including meals and lodging provided by a licensed addiction center.
  • Outpatient care
  • Transportation expenses associated with attending outpatient meetings, including AA groups, if attending on a doctor’s advice.
ALLERGY MEDICINES HCFSA X     Over-the-counter allergy treatments are eligible for reimbursement. Examples include:
  • Actifed
  • Benadryl
  • Chlor-Trimeton
  • Claritin
  • Sudafed
  • Zyrtec
For more information see the OTC Quick Reference Guide.
ALLERGY PRODUCTS HCFSA   X   Eligible expenses include products and home improvements to treat severe allergies. Examples include:
  • Electro-static air purifier
  • HEPA furnace filters and HEPA vacuum cleaner filters (only the difference in cost of the HEPA product minus the standard product can be reimbursed.)
  • Humidifier
  • Home/automobile air conditioners
  • Special vacuum cleaners for persons with respiratory problems (only the difference in cost of the special vacuum cleaner minus a standard vacuum can be reimbursed)
  • Special pillow cases, mattress covers, or other bedding barriers that provide protection against allergens to alleviate an allergic condition

Note: See CAPITAL EXPENSES for important information and guidance.

ALTERNATIVE MEDICINE HCFSA   X   Services must be prescribed and rendered by a licensed health care provider to treat a specific illness or disorder.
AMBULANCE HCFSA X      
ANALGESICS/ANTIPYRETICS HCFSA X     Examples include:
  • Advil
  • Aleve
  • Aspirin
  • Ibuprofen
  • Midol
  • Naprosyn
  • Pamprin
  • Tylenol
For more information, see the OTC Quick Reference Guide.
ANTACIDS/ACID REDUCERS HCFSA X     Examples include:
  • AXID AR
  • Gas-X
  • Maalox
  • Mylanta
  • Pepcid AC
  • Prilosec OTC
  • Tagament HB
  • Tums
  • Zantac 75
For more information, see the OTC Quick Reference Guide.
ANTI-ARTHRITICS HCFSA X     Examples include:
  • Glucosamine
  • Chondroitin
For more information, see the OTC Quick Reference Guide.
ANTIBIOTICS, topical HCFSA X     Examples include:
  • Bacitracin
  • Neosporin
  • Triple Antibiotic Ointment
For more information, see the OTC Quick Reference Guide.
ANTICANDIDAL, yeast infection HCFSA X     Examples include:
  • Femstat 3
  • Gyne-Lotrimin
  • Monistat
  • Mycelex-7
  • Vagistat-1
For more information, see the OTC Quick Reference Guide.
ANTI-DIARRHEAL HCFSA X     Examples include:
  • Immodium AD
  • Kaopectate
  • Pepto-Bismol
For more information, see the OTC Quick Reference Guide.
ANTIFUNGAL HCFSA X     Examples include:
  • Lamisil AT
  • Lotramin AF
  • Micatin
For more information, see the OTC Quick Reference Guide.
ANTIHISTAMINES HCFSA X     See ALLERGY MEDICINES
ANTI-ITCH PRODUCTS, lotions or creams HCFSA X     Examples include:
  • Bactine
  • Benadryl
  • Caldecort
  • Caladryl
  • Calamine
  • Cortaid
  • Hydrocortisone
  • Lanacort
For more information, see the OTC Quick Reference Guide.
ARTIFICIAL REPRODUCTIVE TECHNOLOGIES HCFSA X     Eligible medical expenses include (but are not limited to):
  • Artificial insemination (intracervical, intrauterine, intravaginal)
  • Egg donor charges for recipient
  • Embryo replacement and storage
    • NOTE: Storage fees should not exceed twelve months.
  • Embryo transfer
  • Fertility exams
  • Gamete Intrafallopian Transfer
  • In vitro/In vivo fertilization
  • Sperm bank storage/fees for artificial insemination may be eligible if there is a diagnosis that requires treatment which may impact fertility (see SPERM STORAGE)
  • Sperm implants
  • Sperm washing
  • Reverse vasectomy
ASTHMA MEDICINES HCFSA X     Examples include:
  • Bronitin Mist
  • Bronkaid
  • Bronkolixer
  • Primatene
For more information, see the OTC Quick Reference Guide.
AUTOMOBILE MODIFICATIONS HCFSA   X   See ADAPTIVE EQUIPMENT

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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B Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
BABY FORMULA HCFSA   X   If your baby requires a special formula to treat an illness or disorder, the difference in cost between the special formula and routine baby formula can be reimbursed.
BAND-AIDS/BANDAGES HCFSA X     See the OTC Quick Reference Guide.
BEDBOARDS HCFSA   X    
BEDS, box springs/foundations HCFSA     X  
BEDS, mattresses HCFSA   X   Only unique mattresses specifically described and prescribed by a physician to treat a specific medical condition will be considered. Reimbursement will be limited to a maximum amount of $700 for one mattress purchased every 10 years per participant and/or his or her eligible dependent(s). Any types of support for the mattress, like box springs or special foundations, are not eligible.
BEDSIDE COMMODES HCFSA X      
BEFORE AND AFTER-SCHOOL CARE DCFSA X     Child must be under age 13 or one who is incapable of self-care and can be claimed on your Federal Income Tax return.
BIRTH CONTROL HCFSA X     Birth Control Pills, including (but not limited to):
  • Demulen
  • Depo-Provera
  • Loestrin
  • Lo-Ovral
  • Mircette
  • Ortho Novum
  • Ortho Tri Cylen
  • Ovcon
  • Ovral
  • Tri-Norinyl
  • Triphasil
  • Yasmin
  • Also Included:
    • Condoms
    • Intrauterine Device (IUD)
    • Norplant
    • Ovulation Kits
    • Spermicides
BLOOD PRESSURE MONITORS HCFSA X     See the OTC Quick Reference Guide.
BLOOD STORAGE HCFSA   X   Blood storage is an eligible expense if you are storing blood for use during scheduled elective surgery. Storage fees should not exceed six months.
BODY SCANS HCFSA X      
BOUTIQUE PRACTICE FEES HCFSA     X Monthly or annual fees that your provider may charge for improved access, 24/7 availability and more “personalized” care are not considered medical care and cannot be reimbursed under a health care FSA.
BRAILLE BOOKS AND MAGAZINES HCFSA X     The incremental cost of Braille books and magazines that exceeds the price for regular books and magazines is an eligible expense.
BREAST PUMPS HCFSA   X   Routine use of a breast pump is not an eligible expense.

If the nursing mother (you or your spouse) or your baby has a medical condition that can be relieved through use of a breast pump, the expense of your breast pump can be reimbursed.

BUS FARE HCFSA X     See TRANSPORTATION

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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C Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
CALCIUM SUPPLEMENTS HCFSA   X   Examples include:
  • Calcium Carbonate
  • Calcium Citrate
  • Calcium Gluconate
  • Calcium Lactate
  • Caltrate
  • Citrical
  • Tricalcium Phosphate
For more information, see the OTC Quick Reference Guide.
CAMPS, summer or holiday (Day) DCFSA X    

This includes children under age 13, or any individual who is incapable of self-care and can be claimed on your Federal Tax return.

Payment in advance is not covered. You can only be reimbursed for expenses that have been incurred.

CAMPS, summer or holiday (Overnight) DCFSA     X

Overnight camps are not eligible expenses. Camps that include both day and overnight stays are not eligible even if the provider can separate the day and night expenses. Day care provided during evening/night hours is an eligible expense if you and your spouse work, look for work or attend school full-time during the evenings and nights, such that you need care for your eligible children. However, your children must return to your home during the day (the evening/night day care cannot be 24 hours). If there is any question about whether your camp and/or day care receipts are for eligible expenses, you may be contacted for clarification.

CAPITAL EXPENSE HCFSA   X   A capital expense (permanent or portable) can be reimbursed if its purpose is to provide medical care for you, your spouse or dependent.

Expenses for improvements or special equipment added to your home can be reimbursed if the main purpose of the item is medical care. How much is reimbursed depends on the extent to which the expense permanently improves the property and whether others benefit.

The amount paid for the improvement is reduced by the increase in the value of your home or property. The difference between the cost of the improvement minus the increased value equals the eligible expense.

If the value of your home or property is not increased by the improvement, the entire cost is an eligible expense. Use the Capital Expense Worksheet to determine if your expense is eligible.

Examples of these expenses are:

  • Constructing entrance or exit ramps
  • Widening or otherwise modifying doorways, hallways and stairways
  • Installing railings, support bars, or other modifications to bathrooms
  • Kitchen modifications, including lowering cabinets and other equipment
  • Electrical and plumbing modifications
  • Exterior grading of the property to provide access to your home
  • Removal of carpeting, wall and/or window coverings (this does not include the cost of replacement of these items)

IRS regulations require that the cost comparison between a standard item and an item prescribed by a health care provider be submitted from an independent third party. For instance, you may provide a store circular showing the cost of a comparable standard item when submitting a claim for the reimbursement of the difference on the prescribed item.

This list is not exhaustive. If expenses are similar to those listed above, and are incurred to adapt a personal residence to yours or your spouse’s or dependent’s condition, the expenses are eligible subject to the terms noted above. Expenses must be reasonable, and directly related to the medical condition. Costs that are incurred for architectural or aesthetic reasons are not eligible.

Please refer to IRS Publication 502 for additional information, including operation and upkeep.

CHAIRS, ergonomic HCFSA     X Ergonomic chairs are not eligible.
CHAIRS, reclining HCFSA   X   Reclining chairs that both elevate the legs and tilt the torso may be considered for reimbursement. The chair must be specifically prescribed by a physician to alleviate a specific medical condition and you must submit a fully completed Letter of Medical Necessity that clearly documents how the chair will alleviate the condition or diagnosis for the expense to be considered. Reimbursement will be limited to a maximum amount of $650 for one chair purchased every 10 years per participant and/or his or her dependents. No other types of chairs are eligible.
CHILDBIRTH CLASSES HCFSA X     Does not include:
  • Breastfeeding Classes
  • Newborn or New Infant Care Classes
  • Parenting Classes
CHIROPRACTIC HCFSA X      
CHRISTIAN SCIENCE PRACTITIONERS HCFSA X     Payments for medical care can be reimbursed.
CIALIS HCFSA X      
CIRCUMCISION HCFSA X     A bris performed in the home by a Rabbi is not an eligible expense.
COBRA PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a Health Care FSA.
CO-INSURANCE HCFSA X     Cannot be reimbursed by secondary insurance or any other source.
COLD MEDICINES HCFSA X     Examples include:
  • Actifed
  • Advil Cold and Sinus
  • Alka Seltzer Cold and Flu
  • Children's Advil Cold
  • Dayquil
  • Drixoral
  • Neo-Synephrine 12-Hour
  • Nyquil
  • Pediacare
  • Sudafed
  • Tavist-D
  • Theraflu
  • Triaminic
  • Tylenol Cold and Flu
  • Cough Drops
  • Nasal Sprays
  • Throat Lozenges
See the OTC QRG for more information.
COLD SORE MEDICINES HCFSA X     Examples include:
  • Abreva
  • Herpecin
For more information, see the OTC Quick Reference Guide.
COMPANION ANIMALS HCFSA X     See SERVICE ANIMALS
CONTACT LENSES HCFSA
LEX HCFSA
X     Contact lenses, cleaning and soaking solutions and lens storage cases are all eligible for reimbursement.
CONTROLLED SUBSTANCES HCFSA     X  
CO-PAYMENTS HCFSA X     Cannot be reimbursed by secondary insurance or any other source.
CORD BLOOD STORAGE HCFSA   X   Can be reimbursed if there is a specific medical condition that the cord blood is intended to treat. Indefinite storage “just in case” is not an eligible expense.
CORNEAL RING SEGMENTS HCFSA X      
COSMETIC PROCEDURES HCFSA
LEX HCFSA
    X Cosmetic procedures to improve or enhance appearance are not eligible.
COSMETIC PROCEDURES (cont.) HCFSA
LEX HCFSA
  X   A cosmetic procedure or service necessary to improve a deformity arising from a congenital abnormality, personal injury from accident or trauma, or to restore appearance related to treatment for another medical diagnosis or condition can be reimbursed.
COUGH MEDICINES HCFSA X     Examples include:
  • Chloraseptic
  • Cough drops
  • Mucinex
  • Robitussin
  • Throat lozenges
  • Vicks 44
For more information, see the OTC Quick Reference Guide.
COUNSELING HCFSA X     If counseling is provided to treat a medical or mental diagnosis and is rendered by a licensed provider.

Eligible expenses include psychotherapy, bereavement and grief counseling, sex counseling, etc.

COUNSELING (cont.) HCFSA     X Life coaching, career counseling and marriage counseling do not qualify.
CROWNS HCFSA
LEX HCFSA
X     See DENTAL CARE
CRUTCHES HCFSA X      

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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D Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
DAY CARE DCFSA X    

This includes non-medical day care as well as in-home babysitters for children under age 13, and/or for any individual who is incapable of self-care and can be claimed on your Federal Tax return. You (and your spouse if married) must be working, looking for work (income must be earned during the year), or attending school full-time.

Activities (such as swimming lessons or arts and crafts) are not eligible expenses.

Payment for day care services that have not been incurred - are not eligible for reimbursement. Only expenses for day care that have been incurred are eligible for reimbursement.

DANCING LESSONS HCFSA   X   Only for a short duration and if prescribed for a specific medical condition, such as part of a rehabilitation program after surgery.
DEDUCTIBLES HCFSA X     Cannot be reimbursed by secondary insurance or any other source.
DENTAL MAINTENANCE ORGANIZATION (DMO) HCFSA
LEX HCFSA
    X See INSURANCE PREMIUMS
DENTAL CARE HCFSA
LEX HCFSA
X     Covered services include, but are not limited to:
  • Bridges
  • Cleanings
  • Crowns
  • Dental implants
  • Dentures
  • Endodontic care (root canal)
  • Extractions
  • Fillings
  • Orthodontia
  • Periodontal services
  • Routine prophylaxis
  • Sealants
  • X-rays
DENTAL CARE (cont.) HCFSA
LEX HCFSA
    X Expenses for cosmetic dentistry, such as teeth whitening or bleaching, porcelain veneers, or bonding are not eligible for reimbursement.
DIABETIC SUPPLIES HCFSA X     See the OTC Quick Reference Guide.
DIAPER RASH CREAMS HCFSA X     Examples include:
  • Balmex
  • Desitin
See the OTC Quick Reference Guide for more information.
DIAPERS, DIAPER SERVICE HCFSA     X Not for routine care of a healthy newborn.
DIAPERS, DIAPER SERVICE (cont.) HCFSA   X   To relieve or ameliorate the effect of a particular illness or disease on you, your disabled child or dependent, who would not need this product “but for” the medical condition.
DIETARY SUPPLEMENTS HCFSA   X   Examples include:
  • Ensure
  • Glucerna
  • Power drinks
  • Protein bars
For more information, see the OTC Quick Reference Guide.
DOCTOR FEES HCFSA X     In addition to all expenses for care not reimbursed by any other source, eligible expenses include fees for:
  • Out-of-network providers
  • Charges by your physician for letters of medical necessity to schools, etc.
  • Physician tele-advice, including email communication
DOULAS HCFSA   X   If the doula is a licensed health care professional who renders medical care, his or her fees can be reimbursed.
DRUGS HCFSA       See CONTROLLED SUBSTANCES, PRESCRIPTION DRUGS and OTC
DRUG ADDICTION, treatment of HCFSA X     Eligible expenses include:
  • Inpatient treatment, including meals and lodging provided by a licensed addiction center.
  • Outpatient care
  • Transportation expenses associated with attending outpatient meetings, including AA groups, if attending on a doctor’s advice.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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E Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
EAR CARE HCFSA X     Examples include:
  • Ear drops
  • Ear wax removal
For more information, see the OTC Quick Reference Guide.
EAR PLUGS HCFSA   X   Must be prescribed to treat a specific medical condition, such as the presence of middle/inner ear tubes.
EDUCATION HCFSA   X   Payments made to a special school for a mentally impaired or physically disabled person qualify as reimbursable if the main reason for using the school is its resources for relieving the disability. This includes teaching Braille to a visually impaired person, teaching lip reading to a hearing impaired person, and giving remedial language training to correct a condition caused by a birth defect.
ELDER CARE DCFSA X     Adult must live with you at least 8 hours a day and be claimed as a dependent on your Federal Tax return.
ELECTROLYSIS HCFSA     X  
ELECTROLYTE REPLACEMENTS HCFSA X     Examples include:
  • Pedialyte
For more information, see the OTC Quick Reference Guide.
EYE CARE HCFSA X     Examples include:
  • Eye drops
  • Eye patches
  • Reading glasses
For more information, see the OTC Quick Reference Guide.
EYEGLASSES/EYE EXAMS HCFSA
LEX HCFSA
X     Includes prescription sunglasses and reading glasses (even those purchased over-the-counter).
EXERCISE EQUIPMENT HCFSA   X    
EXERCISE PROGRAMS HCFSA   X   See also FITNESS PROGRAMS; WEIGHT LOSS PROGRAMS.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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F Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
FEMININE HYGIENE PRODUCTS HCFSA   X   Feminine hygiene products used post-surgery or after childbirth may be reimbursed. See the OTC Quick Reference Guide.
FERTILITY ENHANCEMENT HCFSA X     Includes ovulation predictor kits and pregnancy tests.
FIBER SUPPLEMENTS HCFSA   X   Examples include:
  • Benefiber
  • Metamucil
For more information, see the OTC Quick Reference Guide.
FINANCE CHARGES HCFSA
LEX HCFSA
    X  
FINANCE CHARGES (cont.) DCFSA     X  
FIRST AID KIT/SUPPLIES HCFSA X     Examples include:
  • Antiseptics
  • Bandages
  • Cold/Hot Packs
  • Joint Supports
  • Liquid bandages
  • Peroxide
  • Rubbing Alcohol
  • Splints
See the OTC Quick Reference Guide.
FITNESS PROGRAMS HCFSA   X   Fees paid for a fitness program may be an eligible expense if prescribed by a physician and substantiated by his or her statement that treatment is necessary to alleviate a medical problem. You cannot be reimbursed for expenses that will be incurred in the future, even if the provider requires payment in advance for the entire period. You can provide a receipt for the entire period and several receipts incrementally that detail the dates of service, provider name and cost after the date of service that corresponds to each time increment.
FLUORIDE RINSE/PILLS HCFSA X     Examples include:
  • Act
  • Colgate Phos-flur
For more information, see the OTC QRG.
FLU SHOTS HCFSA X      
FOOD HCFSA   X  

Food may be eligible if prescribed by a medical practitioner to treat a specific illness or ailment and if the food does not substitute for normal nutritional requirements. However, the amount that may qualify for reimbursement is limited to the amount by which the cost of the food exceeds the cost of commonly available versions of the same product.

FOOT CARE HCFSA X     Examples include:
  • Arch and insole supports
  • Antifungal products
  • Bunion, blister and corn treatments
  • Callous removers
For more information, see the OTC Quick Reference Guide.
FUNERAL EXPENSES HCFSA     X  

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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G Print This Section
Condition/Type of Service/Expense HCFSA Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
GLUCOSAMINE HCFSA X     See the OTC Quick Reference Guide.
GUIDE DOGS HCFSA X     See SERVICE ANIMALS
GYM MEMBERSHIP HCFSA   X   Fees paid for a gym membership may be an eligible expense if prescribed by a physician and substantiated by his or her statement that treatment is necessary to alleviate a medical problem. You cannot be reimbursed for expenses that will be incurred in the future, even if the provider requires payment in advance for the entire period. You can provide a receipt for the entire period and several receipts incrementally that detail the dates of service, provider name and cost after the date of service that corresponds to each time increment.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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H Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
HAIR LOSS TREATMENT HCFSA   X   May be eligible when used to treat hair loss due to a specific medical condition.
HAIR TRANSPLANT HCFSA     X See COSMETIC PROCEDURES
HAND SANITIZER HCFSA X     Examples include:
  • Germ-X
  • Nexcare
  • Purell
This does not include soaps, lotions or other personal hygiene items that include sanitizing ingredients; they are not eligible. Please refer to OTC Quick Reference Guide
HEALING OINTMENTS HCFSA   X   Examples include:
  • Aquaphor by Eucerin
For more information, see the OTC QRG.
HEALTH SCREENINGS HCFSA X     See PREVENTIVE CARE SCREENINGS
HEARING AIDS HCFSA X     Includes batteries
HEMORRHOIDAL TREATMENTS HCFSA X     Examples include:
  • Preparation H
  • Tronolane
See the OTC Quick Reference Guide for more information.
HOME DIAGNOSTIC KITS/TESTS HCFSA X     Examples include:
  • Blood pressure monitors
  • Cholesterol tests
  • Colorectal screenings
  • Diabetic equipment and supplies
  • HIV tests
  • Pregnancy tests
See the OTC Quick Reference Guide for more information.
HOME MEDICAL EQUIPMENT HCFSA X     Home medical equipment may require a letter of medical necessity (LMN) for reimbursement.
HOMEOPATHIC CARE HCFSA X     Homeopathic care rendered by a licensed health care professional who provides this care for the treatment of a specific illness or disorder for you, your spouse or dependent can be reimbursed under a HCFSA.
HOMEOPATHIC MEDICINES HCFSA   X   Homeopathic medicines used for treatment of a specific illness or disorder can be reimbursed. See the OTC Quick Reference Guide.
HORMONE SUPPLEMENTS, OTC HCFSA   X   Supplements used for relief of peri-menopausal or menopausal symptoms may be reimbursed. See the OTC Quick Reference Guide.
HOUSEHOLD HELP HCFSA     X  
HOUSEHOLD HELP (cont.) DCFSA   X   Duties must include caring for an eligible dependent.
HUMIDIFIERS HCFSA   X   See ALLERGY RELIEF, CAPITAL EXPENSES
HYDROTHERAPY HCFSA   X    
HYPNOSIS HCFSA X      

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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I Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
IMMUNIZATIONS HCFSA X     Includes those recommended for overseas travel
INCONTINENCE PRODUCTS HCFSA   X   Incontinence products used for a diagnosed medical condition may be reimbursed. Examples include:
  • Attends
  • Poise
See the OTC Quick Reference Guide.
INSURANCE PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.
IN VITRO FERTILIZATION HCFSA X     See ARTIFICIAL REPRODUCTIVE TECHNOLOGIES

*Please note, all "potentially health care eligible expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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L Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
LAB FEES HCFSA X      
LACTATION CONSULTANT HCFSA   X   Services rendered by a licensed health care provider can be reimbursed.
LACTOSE INTOLERANCE SUPPLEMENTS HCFSA X     Examples include:
  • DairyCare
  • Digestive Advantage
  • Lactaid
See the OTC Quick Reference Guide.
LAMAZE CLASSES HCFSA X      
LASER EYE SURGERY HCFSA
LEX HCFSA
X     See VISION CARE
LATE PAYMENT FEES DCFSA     X  
LATE PICK-UP FEES DCFSA X      
LEAD-BASED PAINT REMOVAL HCFSA X     Expenses for removing lead-based paints from surfaces in your home to prevent a child who has, has had, or is in danger of lead poisoning from eating the paint can be reimbursed. These surfaces must be in poor repair and within a child’s reach.

The cost of repainting the affected area(s) is not an eligible expense. If you cover the area with wallboard or paneling instead of removing the lead paint, these items will be treated as capital expenses.

LEARNING DISABILITIES HCFSA   X   The portion of tuition/tutoring fees covering services rendered specifically for your child's severe learning disabilities caused by mental or physical impairments (such as nervous system disorders, or closed head injuries) and paid to a special school or to a specially-trained teacher may be reimbursed under a HCFSA if prescribed by a physician. Examples of eligible expenses include:
  • Remedial reading for your child or dependent with dyslexia
  • Testing to diagnose
LEGAL FEES HCFSA   X   Legal fees paid to authorize treatment for mental illness are eligible expenses.
LEVITRA HCFSA X      
LIFETIME CARE HCFSA     X Fees or advance payments made to a retirement home or continuing care facility are not eligible expenses.
LODGING HCFSA   X   Up to $50 per night is eligible if the following conditions are met:
  • The lodging is primarily for, and essential to, medical care
  • The medical care is provided by a doctor in a licensed hospital or medical care facility related to/equivalent to a licensed hospital
  • The lodging is not lavish or extravagant
  • There is no significant element of personal pleasure or leisure in the travel.
LODGING, for companion HCFSA   X   Your companion’s lodging can be reimbursed if he or she is accompanying the patient (you or your eligible dependents) for medical reasons and it meets the criteria listed above. Meals are not eligible for reimbursement.

Example: Parents traveling with a sick child, up to $100 per night ($50 per person) may be reimbursed, as well as lodging and pre and post-hospitalization for bone marrow transplants.

LODGING, special HCFSA   X   The cost of a special home or step-down facility for your mentally handicapped dependent, recommended by a psychiatrist to help your dependent adjust after inpatient mental health care to community living, can be reimbursed.
LONG-TERM CARE INSURANCE PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a HCFSA.
LONG-TERM CARE SERVICES HCFSA     X Refer to Section 106(c) of the IRS Code for more information.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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M Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
MASSAGE THERAPY HCFSA     X To reduce stress or improve general health.
MASSAGE THERAPY (cont.) HCFSA   X   If prescribed by a physician for a specific illness, injury, trauma or condition.
MATERNITY AIDS HCFSA       See PREGNANCY AIDS
MATERNITY CLOTHES HCFSA     X  
MEALS HCFSA     X  
MEDICAL ALERT BRACELET HCFSA X      
MEDICAL INFORMATION HCFSA X     Amounts paid to a plan that maintains electronic medical information for you, your spouse or dependents are eligible for reimbursement under an HCFSA.
MEDICAL RECORDS HCFSA X     Costs associated with copying or transferring medical records to a new provider are eligible for reimbursement.
MEDICAL SAVINGS ACCOUNTS HCFSA     X  
MEDICAL SERVICES HCFSA X     Expenses for medical services prescribed by physicians or other health care providers acting within their scope of licensure can be reimbursed under a HCFSA.
MEDICAL SUPPLIES HCFSA X     Please refer to OTC Quick Reference Guide
MEDICATED LIP PRODUCTS HCFSA X     Medicated lip products that are used to treat severely dry, chapped lips or cold sores are eligible for reimbursement from your HCFSA. Examples include:
  • Blistex Medicated Lip Ointment
  • Carmex Medicated Lip Balm
  • Neosporin Lip Treatment
Please refer to OTC Quick Reference Guide. Non-medicated lip products with moisturizers are not eligible.
MENSTRUAL RELIEF HCFSA X     Examples include:
  • Midol
  • Pamprin
  • Premysyn PMS
Please refer to OTC Quick Reference Guide
MIGRAINE RELIEF HCFSA X     Examples include:
  • Advil Migraine
  • Excedrin
  • Motrin Migraine
Please refer to OTC Quick Reference Guide
MILEAGE HCFSA X    

The mileage rate from January 1 - June 30, 2008 is 19 cents per mile, and from July 1 - December 31, 2008 the mileage rate is 27 cents per mile for medical care received during the 2008 calendar year.

Beginning January 1, 2009 the mileage rate will be 24 cents per mile.

Be sure to include the date(s) of service and number of miles traveled for reimbursement.

MINERALS HCFSA   X   Examples include:
  • Calcium
  • Caltrate
  • Feosol
  • Ferrous Sulfate
  • Folic Acid
Please refer to OTC Quick Reference Guide
MISSED APPOINTMENT FEES HCFSA     X  
MOTION SICKNESS MEDICINES HCFSA X     Examples include:
  • Bonine
  • Dramamine
  • Marizine
Please refer to OTC Quick Reference Guide

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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N Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
NASAL STRIPS HCFSA X     Nasal strips that are used to alleviate snoring or reduce nasal congestion are eligible for reimbursement from your HCFSA. Examples include:
  • Breathe Right
  • Snorezz
Please refer to OTC Quick Reference Guide.
NATUROPATHIC CARE HCFSA   X   Naturopathic care rendered by a licensed health care professional who provides this care for the treatment of a specific illness or disorder for you, your spouse or dependent can be reimbursed under a HCFSA.
NON-COVERED SERVICES HCFSA X     Medical care or services that are not covered under your FEHB plan may be reimbursed under an HCFSA.
NEWBORN NURSING CARE HCFSA     X Nursing services for a normal, healthy newborn are not an eligible expense.
NURSING CARE AND SERVICES (private duty nursing) HCFSA   X   Nursing services are an eligible expense, whether provided in your home or another facility. The nurse need not be an R.N. or L.P.N., so long as the services rendered are of a kind generally performed by a nurse. These include services directly related to caring for and monitoring your, your spouse’s or dependent’s condition, including:
  • Preparing and giving medication
  • Changing dressings and providing wound care
  • Monitoring vital signs
  • Assessing responses to prescribed treatments, and documenting those assessments in written notes

If the individual providing nursing services also provides household and personal services, only those charges related to actual nursing care are eligible expenses.

NURSING HOME HCFSA   X   Expenses for medical care in a nursing home for you, your spouse and dependent(s), including meals and lodging may be reimbursed if the main purpose of the stay is to receive medical care.

If the primary reason for confinement is personal (i.e., you or your spouse or dependent needs assistance with activities of daily living, safety issues, etc.), only the portion of the cost that is directly related to medical care or nursing services may be reimbursed.

NUTRITIONAL SUPPLEMENTS HCFSA   X   Dietary, nutritional, and herbal supplements, vitamins, and natural medicines are not reimbursable if they are merely beneficial for general health. However, they may be reimbursable if recommended by a medical practitioner to treat a specific medical condition.
NUTRITIONIST HCFSA   X   Nutritional services related to the treatment and guidance of a specific diagnosis or medical condition can be reimbursed.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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O Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
OCCUPATIONAL THERAPY HCFSA X      
OPTOMETRIST HCFSA
LEX HCFSA
X      
ORAL CARE HCFSA X     Examples include:
  • Anbesol
  • Orajel
Please refer to OTC Quick Reference Guide
ORTHODONTIA HCFSA
LEX HCFSA
X     See Orthodontia Quick Reference Guide for more information.
ORTHOPEDIC SHOES HCFSA   X   Only shoes custom-fitted to the wearer’s feet are eligible. Only the cost difference between the custom-made shoe and a regular comparable shoe is reimbursable. Mass produced shoes are not eligible.
ORTHOTICS HCFSA X     Custom-made and over-the-counter inserts are eligible for reimbursement.
OSTEOPATH HCFSA X      
OVER-THE-COUNTER MEDICINES AND SUPPLIES HCFSA X     See OTC Quick Reference Guide for more details
OVER-THE-COUNTER MEDICINES AND SUPPLIES (cont.) LEX HCFSA X     Eligible dental or vision over-the-counter expenses, such as denture care products, and contact lens cleaning, soaking solutions and lens cases may be reimbursed.
OVULATION MONITOR HCFSA X      
OXYGEN HCFSA   X    

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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P Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
PAIN RELIEVERS HCFSA X     Examples include:
  • Advil
  • Aleve
  • Aspirin
  • Ibuprofen
  • Midol
  • Naprosyn
  • Pamprin
  • Tylenol
For more information, see the OTC Quick Reference Guide.
PARENTAL FEES HCFSA     X Fees or premiums paid to participate in a state-funded assistance program for the medical care of disabled dependents are not eligible for reimbursement from your HCFSA.
PARKING FEES AND TOLLS HCFSA X     See TRANSPORTATION
PATTERNING EXERCISES HCFSA   X   While these exercises are often done by family members, the expense to hire someone to perform patterning exercises is an eligible expense.
PEDICULICIDE HCFSA X     Examples include:
  • Nix
  • Rid
Please refer to OTC Quick Reference Guide
PENILE IMPLANTS HCFSA   X   Amounts paid for implants may be eligible if the diagnosis of impotence is due to organic causes, such as diabetes, post-prostatectomy complications, or spinal cord injury.
PERSONAL ITEMS HCFSA     X Items that are used for personal grooming and not to treat a specific medical condition are not eligible for reimbursement.
PHYSICAL THERAPY HCFSA X      
PHYSICIAN FEES, Pre-paid HCFSA     X Pre-paid physician fees that cover the cost of services such as exams, physicals, screenings, check-ups and immunizations, are not eligible for reimbursement. A common example is an annual pre-paid fee to access the services of an on-staff physician.
PILLOWS, lumbar support HCFSA   X   Pillows or cushions that provide lumbar support may be eligible for reimbursement if prescribed by a licensed health care provider to alleviate a specific medical condition.
PLACEMENT SERVICES DCFSA X     The up-front fee may qualify if it is an expense that must be paid in order to obtain care. However, the fee can only be reimbursed proportionately over the duration of the agreement to employ the dependent care provider, such as an au pair. The weekly stipend, as well as other work-related expenses, may also qualify as an expense for the care of a qualifying individual.
POST-MASTECTOMY CLOTHING HCFSA X     Prosthetic bras and related clothing purchased after any surgical procedure related to breast cancer (lumpectomy, mastectomy, etc.) are eligible for expenses. Prosthetic bras and inserts are reimbursable at 100%. Tank tops or swimwear with built-in prosthetic bras are reimbursed up to 50% of the total cost not to exceed $75.
PREGNANCY AIDS HCFSA X     Items that relieve or reduce the discomfort of pregnancy may be reimbursed under a HCFSA. Examples include:
  • Maternity girdles
  • Elastic hosiery
  • Maternity support belts
PREGNANCY TESTS HCFSA X     See OTC QRG for more information.
PRESCRIPTION DRUG DISCOUNT PROGRAM HCFSA     X Fees paid to get access to drugs at a reduced cost are not eligible for reimbursement under a HCFSA. Actual costs paid for prescription drugs are an eligible expense.
PRESCRIPTION DRUGS HCFSA X     Eligible expenses include deductibles, co-payments or co-insurance as well as the costs for prescription drugs that may not be covered under FEHB, such as drugs that treat erectile dysfunction. Your claim form should include the name of the drug, the provider's name and the date of service.
PRESCRIPTION DRUGS - IMPORTED HCFSA   X   With rare exception, a prescription drug purchased outside of the United States is not eligible for reimbursement from an FSA. However, if the FDA has approved importing a prescription drug into the U.S. under the “Compassionate Use Act”, it may be an eligible expense. This includes drugs recommended for treatment of a serious condition for which effective treatment may not be available in the U.S., or to continue treatment of a serious condition that was begun in a foreign country. Please see the prescription drug FAQ on the Summary of Benefits for more information.
PREVENTIVE CARE SCREENINGS HCFSA X     If the tests are designed to assess symptoms of a medical diagnosis, they are eligible for reimbursement. Examples include clinic and home testing kits for blood pressure, glaucoma, cataracts, hearing, cholesterol, etc.
PROSTHETICS HCFSA X      
PSYCHIATRIC SERVICES AND CARE HCFSA X      
PSYCHOANALYSIS HCFSA X      
PSYCHOLOGIST HCFSA X      

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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R Print This Section
Condition/Type of Service/Expense HCFSA Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
RADON MITIGATION HCFSA   X   If a physician requires radon mitigation in your home due to a medical condition caused or aggravated by an unacceptable level of radon, some expenses may be eligible. However, if the home’s value is increased due to the mitigation, some or all of the expenses may not be reimbursable. Use the Capital Expense Worksheet to determine how much of the expense is eligible.
READING GLASSES HCFSA
LEX HCFSA
X     See EYEGLASSES
RETIN-A HCFSA X      
ROGAINE HCFSA   X   See OTC Quick Reference Guide

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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S Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
SALES TAX HCFSA       See TAXES
SERVICE ANIMALS HCFSA X     Expenses to train or procure any guide dog, signal dog, or other animal individually trained to provide assistance to you, your spouse or dependent with a disability can be reimbursed under a HCFSA. Expenses such as food, medications, vet visits, and dental care products needed for the care or maintenance of service animals are eligible expenses.
SHIPPING AND HANDLING HCFSA X     Shipping and handling charges for medical needs, such as mail-order prescriptions and eligible over-the-counter items.
SLEEP AIDS HCFSA X     Examples include:
  • Nytol
  • Sominex
  • Tylenol PM
  • Unisom
Please refer to OTC Quick Reference Guide.
SMOKING CESSATION MEDICINES HCFSA X     Examples include:
  • Commit
  • Nicoderm CQ
  • Nicorette
  • Nicotrol
See OTC Quick Reference Guide.
SMOKING CESSATION PROGRAMS HCFSA X      
SPECIAL EDUCATION AND SCHOOLS HCFSA   X   See LEARNING DISABILITIES
SPECIAL FOODS HCFSA   X   If prescribed by a physician to treat a special illness or ailment, and not merely as a substitute for normal nutritional requirements.

The amount that can be reimbursed is limited to the amount that the special food exceeds the cost of commonly available versions of the same product.

SPECIALIZED EQUIPMENT OR SERVICES HCFSA       See ADAPTIVE EQUIPMENT
SPEECH THERAPY HCFSA X      
SPERM STORAGE HCFSA   X   Storage fees can be reimbursed if you, your spouse or dependent has a cancer or blood dyscrasia diagnosis that requires chemotherapy or whole body radiation which may affect future ability to conceive children. NOTE: Storage fees should not exceed twelve months.
STERILIZATION PROCEDURES HCFSA X      
STERILIZATION REVERSAL HCFSA X      
STUDENT HEALTH FEE HCFSA     X  
SUBSTANCE ABUSE HCFSA X     See ALCOHOLISM
SUBWAY FARE HCFSA X     See TRANSPORTATION
SUNBURN/BURN RELIEF HCFSA X     Examples include:
  • Aloe Vera
  • Solarcaine
Please refer to OTC Quick Reference Guide
SUN-PROTECTIVE CLOTHING HCFSA   X   Clothing that offers at least 30+ UVA and UVB sun protection for individuals with melanoma or other skin cancer, systemic lupus erythematosus (SLE), acute cutaneous lupus (ACLE) or other significant dermatologic conditions may be eligible with a letter of medical necessity from your doctor. The clothing is reimbursed for the difference between “normal” apparel and this specially-constructed clothing up to 33% of the total cost. The receipt must show the purchase was from an accredited sun-protective company such as Solumbra® or Coolibar®.
SUNSCREEN HCFSA X     Sunscreen products with an SPF 30 or higher are eligible. Lotions or cosmetics that contain ingredients to protect you from the sun and/or list a SPF are not eligible. See OTC Quick Reference Guide

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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T Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
TANNING SALON OR EQUIPMENT HCFSA     X No, if just to improve general health or appearance.
TANNING SALON OR EQUIPMENT (cont.) HCFSA   X   May be reimbursed under a HCFSA for treatment of certain skin disorders, such as eczema and psoriasis.
TAXES HCFSA X     Taxes on medical services and products may be reimbursed under a HCFSA. This includes local, state, service and other taxes.
TAXI FARE HCFSA X     See TRANSPORTATION
TEETH WHITENING HCFSA
LEX HCFSA
    X Teeth whitening products or services to enhance the brightness of your teeth are cosmetic and cannot be reimbursed.
TEETH WHITENING (cont.) HCFSA
LEX HCFSA
  X   Teeth whitening performed to restore function after an injury or trauma or to correct a congenital disease can be reimbursed.
TELEPHONE FOR HEARING IMPAIRED HCFSA X     Expenses associated with purchasing or repairing special telephone equipment for you, your spouse or dependent with a hearing impairment are eligible for reimbursement under a HCFSA.
TELEVISION FOR HEARING IMPAIRED HCFSA   X   Expenses for equipment that displays the audio of television programming as subtitles for hearing impaired persons are eligible for reimbursement under a HCFSA.

The eligible expense is limited to the cost that exceeds the cost of a non-adapted set.

See CAPITAL EXPENSES.

TEMPORARY CONTINUATION OF COVERAGE (TCC) PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.
TOOTHBRUSHES HCFSA     X Toothbrushes, including electric or battery-powered, are personal care items and not eligible for reimbursment.
TRAIN FARE HCFSA X     See TRANSPORTATION
TRANSPORTATION HCFSA   X  

Costs of transportation to/from locations of medical care/service may be eligible for reimbursement from your health care FSA, but only if certain requirements are met. Please click here for details.

TRANSPORTATION, to and from the day/elder care provider DCFSA     X Transportation to and from the day care or elder care location is not eligible.
TRICARE PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.
TRIPS HCFSA     X Excursions taken for a change in environment, general health improvement etc., even those taken on the advice of your health care provider are not an eligible expense.
TUITION EXPENSES OR FEES HCFSA   X    

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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U Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
UCR, CHARGES ABOVE HCFSA X     Medical expenses in excess of your plan’s usual, customary and reasonable (UCR) charges may be reimbursed under a HCFSA if the underlying expense is eligible.
ULTRASOUND, PRE-NATAL HCFSA   X   An ultrasound ordered by your physician to monitor fetal growth, and/or to diagnose, treat or monitor a pregnancy-related condition is a covered expense under your HCFSA, even if your health plan does not provide reimbursement. An ultrasound not ordered or performed by a physician or other licensed professional, and/or not intended to diagnose, treat or monitor a pregnancy-related condition is not an eligible expense.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

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V Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
VASECTOMY HCFSA X      
VASECTOMY REVERSAL HCFSA X     See STERILIZATION REVERSAL
VIAGRA HCFSA X      
VISION CARE HCFSA
LEX HCFSA
X      
VISION DISCOUNT PROGRAMS HCFSA
LEX HCFSA
    X Fees paid to gain access to a vision network, or to a reduced fee structure are not an eligible expense under a HCFSA.

See INSURANCE PREMIUMS

VITAMIN B-12 INJECTIONS HCFSA X      
VITAMINS HCFSA   X   See the OTC Quick Reference Guide.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms from which you, your spouse or dependent are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed.

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  Back to top

W Print This Section
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
WALKERS HCFSA X      
WART REMOVAL HCFSA X     Examples include:
  • Compound W
  • Dr. Scholl's Clear Away
  • Wart-Off
Please refer to OTC Quick Reference Guide.
WATER FLUORIDATION HCFSA   X    
WEIGHT LOSS DRUGS HCFSA   X   Drugs prescribed by a health care provider for weight loss are eligible. However, OTC drugs, such as Alli, are only potentially eligible. See the OTC Quick Reference Guide.
WEIGHT LOSS PROGRAMS HCFSA   X   Food is not eligible, even if it is part of the weight loss program. See FOOD
WELL-BABY/WELL-CHILD CARE HCFSA X      
WHIRLPOOL BATHS HCFSA   X   See CAPITAL EXPENSE
WHEELCHAIRS HCFSA X      
WIG HCFSA   X   The full cost of a wig purchased because the patient has lost all of his or her hair from disease or treatment.

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Eligible expenses listed here are subject to change without notice.