Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: B

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
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

Eligible expenses listed here are subject to change without notice.