Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: A

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.

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

Eligible expenses listed here are subject to change without notice.