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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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:
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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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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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:
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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|
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: 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
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|
Condition/Type of Service/Expense |
Account Type |
Eligible Expense |
Potentially Eligible Expense* |
Not Eligible |
Additional Information |
EAR CARE |
HCFSA |
X |
|
|
Examples include:
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:
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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|
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:
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:
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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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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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: 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:
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: 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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|
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: 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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|
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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|
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|
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:
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:
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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|
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|
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: 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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|
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|
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:
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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|
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:
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
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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 |
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|
See EYEGLASSES |
RETIN-A |
HCFSA |
X |
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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
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Condition/Type of Service/Expense |
Account Type |
Eligible Expense |
Potentially Eligible Expense* |
Not Eligible |
Additional Information |
SALES TAX |
HCFSA |
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See TAXES |
SERVICE ANIMALS |
HCFSA |
X |
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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 |
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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 |
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|
Examples include: - Commit
- Nicoderm CQ
- Nicorette
- Nicotrol
See OTC Quick Reference Guide. |
SMOKING CESSATION PROGRAMS |
HCFSA |
X |
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SPECIAL EDUCATION AND SCHOOLS |
HCFSA |
|
X |
|
See LEARNING DISABILITIES |
SPECIAL FOODS |
HCFSA |
|
X |
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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 |
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SPERM STORAGE |
HCFSA |
|
X |
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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 |
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STERILIZATION REVERSAL |
HCFSA |
X |
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STUDENT HEALTH FEE |
HCFSA |
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X |
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SUBSTANCE ABUSE |
HCFSA |
X |
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See ALCOHOLISM |
SUBWAY FARE |
HCFSA |
X |
|
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See TRANSPORTATION |
SUNBURN/BURN RELIEF |
HCFSA |
X |
|
|
Examples include:
Please refer to OTC Quick Reference Guide |
SUN-PROTECTIVE CLOTHING |
HCFSA |
  |
X |
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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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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 |
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May be reimbursed under a HCFSA for treatment of certain skin disorders, such as eczema and psoriasis. |
TAXES |
HCFSA |
X |
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Taxes on medical services and products may be reimbursed under a HCFSA. This includes local, state, service and other taxes. |
TAXI FARE |
HCFSA |
X |
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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 |
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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 |
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|
See TRANSPORTATION |
TRANSPORTATION |
HCFSA |
|
X |
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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.
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TRICARE PREMIUMS |
HCFSA |
|
|
X |
Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA. |
TRIPS |
HCFSA |
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|
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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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
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|
Condition/Type of Service/Expense |
Account Type |
Eligible Expense |
Potentially Eligible Expense* |
Not Eligible |
Additional Information |
VASECTOMY |
HCFSA |
X |
|
|
|
VASECTOMY REVERSAL |
HCFSA |
X |
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See STERILIZATION REVERSAL |
VIAGRA |
HCFSA |
X |
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|
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VISION CARE |
HCFSA LEX HCFSA |
X |
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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 |
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|
|
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.
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W
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|
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 |
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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 |
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Food is not eligible, even if it is part of the weight loss program. See FOOD |
WELL-BABY/WELL-CHILD CARE |
HCFSA |
X |
|
|
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WHIRLPOOL BATHS |
HCFSA |
|
X |
|
See CAPITAL EXPENSE |
WHEELCHAIRS |
HCFSA |
X |
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WIG |
HCFSA |
|
X |
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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.
|