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