Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: D

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 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 for which you, your spouse, dependent or adult child through age 26 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. You must submit a new LMN each year if the medical condition persists - they cannot be approved indefinitely.

As of January 1, 2011 eligible over-the-counter (OTC) products that are medicines or drugs (e.g., acne treatments, allergy and cold medicines, antacids, etc.) will only be eligible for reimbursement from your Health Care FSA with a physician's prescription that includes his or her address and license number, as stated in IRS Notice 2010-59. The only exception is insulin - which will not require a prescription. OTC products or items that are not considered medicines or drugs, such as bandages and nasal strips, will continue to be eligible without a prescription. For information on submitting OTC expenses, see the OTC Quick Reference Guide.

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. You must include the provider's SSN or TIN with your claim. If you are unable to obtain this information, you must include a signed letter showing that you attempted to obtain this information. The letter must include the provider's name and mailing address.
DANCING LESSONS (Coverage Code 104)	HCFSA		X		If prescribed for a specific medical condition, such as part of a rehabilitation program after surgery.
DEDUCTIBLES (Coverage Code 104)	HCFSA	X			Cannot be reimbursed by secondary insurance or any other source.
DEFIBRILLATOR, portable (Coverage Code 104)	HCFSA	X
DENTAL MAINTENANCE ORGANIZATION (DMO)	HCFSA LEX HCFSA			X	See INSURANCE PREMIUMS
DENTAL CARE (Coverage Code 202)	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
DIABETIC SUPPLIES (Coverage Code 102)	HCFSA	X			Diabetic socks are eligible, but only the cost difference between the diabetic socks and regular socks will be reimbursed.
DIAPER RASH CREAMS (Coverage Code 102)	HCFSA	X			Examples include: A+D Ointment Aveeno Diaper Rash Cream Balmex Boudreaux's Butt Paste Desitin For more information on submitting OTC expenses, see the OTC Quick Reference Guide.
DIAPERS, DIAPER SERVICE	HCFSA			X	Not for routine care of a healthy newborn.
DIAPERS, DIAPER SERVICE (cont.) (Coverage Code 104)	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 (Coverage Code 102)	HCFSA		X		Examples include: Ensure Glucerna Power drinks Protein bars Meal replacements are not eligible. Dietary supplements must be necessary to treat a specific medical condition. For more information on submitting OTC expenses, see the OTC Quick Reference Guide.
DOCTOR FEES (Coverage Code 104)	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 (Coverage Code 104)	HCFSA		X		If the doula is a licensed health care professional who renders medical care, his or her fees can be reimbursed. Typically doulas do not provide medical care. A licensed medical provider, such as the patient's OB/GYN must provide a statement detailing that a medical service was provided by the doula in order to be considered for reimbursement.
DRUGS	HCFSA				See PRESCRIPTION DRUGS and OTC MEDICINES
DRUG ADDICTION, treatment of (Coverage Code 104)	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: Eligible expenses listed here are subject to change without notice.