Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: O

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*	OTC Prescription Required	Additional Information
OCCLUSAL/BITE GUARDS (Coverage Code 202)	HCFSA LEX HCFSA	X			This does not include mouth guards used for sports activities.
OCCUPATIONAL THERAPY (Coverage Code 104)	HCFSA	X
OPTOMETRIST (Coverage Code 303)	HCFSA LEX HCFSA	X
ORAL CARE (Coverage Code 117)	HCFSA			X	Examples include: Anbesol Biotene Dry Mouth Mouthwash Orajel Oral Balance For information on submitting OTC expenses, see the OTC Quick Reference Guide.
ORTHODONTIA (Coverage Code 203)	HCFSA LEX HCFSA	X			See Orthodontia Quick Reference Guide for more information.
ORTHOPEDIC SHOES (Coverage Code 104)	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.
ORTHOTIC INSERTS (Coverage Code 102)	HCFSA	X			Custom-made and over-the-counter inserts are eligible for reimbursement.
OSTEOPATH (Coverage Code 104)	HCFSA	X
OVER-THE-COUNTER MEDICINES/DRUGS (Coverage Code 117)	HCFSA			X	For information on submitting OTC expenses, see the OTC Quick Reference Guide.
OVER-THE-COUNTER SUPPLIES (Coverage Code 102)	HCFSA	X			For information on submitting OTC expenses, see the OTC Quick Reference Guide.
OVER-THE-COUNTER SUPPLIES (Coverage Code 102)	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 (Coverage Code 102)	HCFSA	X
OXYGEN (Coverage Code 104)	HCFSA		X

PLEASE NOTE: Eligible expenses listed here are subject to change without notice.