Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: R

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	HCFSA	Eligible Expense	Potentially Eligible Expense*	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

Eligible expenses listed here are subject to change without notice.