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 for 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:
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.
|