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 |
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:
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 |
Eligible expenses listed here are subject to change without notice.
|