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 |
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.
|