FSA Eligible Expenses






Services listed in this document are eligible for reimbursement, if they 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.

 

  Eligible expenses listed here are subject to change without notice.

*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. This letter must be submitted with every claim.

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A
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional 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 Covered with a letter of medical necessity.
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 PRODUCTS HCFSA   X   Eligible expenses include products and home improvements to treat severe allergies. Examples include:
  • Electro-static air purifier
  • Humidifier
  • Home air conditioners
  • Pillows, mattress covers, etc. 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      
ARTIFICIAL REPRODUCTIVE TECHNOLOGIES HCFSA X     Eligible medical expenses include (but are not limited to):
  • Fertility exams
  • Artificial insemination (intracervical, intrauterine, intravaginal)
  • In-vitro/In-vivo fertilization
  • Gift
  • Sperm bank storage/fees for artificial insemination
    • NOTE: Storage fees should not exceed twelve months.
  • Sperm implants
  • Sperm washing
  • Reverse vasectomy
  • Embryo replacement and storage
    • NOTE: Storage fees should not exceed twelve months.
  • Egg donor charges for recipient
  • Embryo transfer
AUTOMOBILE MODIFICATIONS HCFSA       See ADAPTIVE EQUIPMENT

*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. This letter must be submitted with every claim.

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B
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 OTC
BED BOARDS HCFSA   X    
BEDSIDE COMMODES HCFSA X      
BED WETTING ALARM
HCFSA X Covered for children 5 years of age or older. BIRTH CONTROL HCFSA X     Birth Control Pills, including (but not limited to):
  • Demuelon
  • Ortho-Novum
  • Genora Ovcon
  • Levelen
  • Ovral
  • Loestrin Syntex
  • Lo-Ovral
  • Tri-Levelen Modicon
  • Tri-Norinyl
  • Nordette Triphasil
  • Norinyl
  • Also Included:
    • Condoms
    • Norplant
    • Ovulation Kits
    • Spermicides
BLOOD PRESSURE MONITORS HCFSA X     See OTC 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 This includes lactation supplies.

*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. This letter must be submitted with every claim.

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C
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
CAPITAL EXPENSE HCFSA   X   A capital expense (permanent or portable) can be reimbursed if its purpose is to provide medical care for you, your spouse or dependent.

Expenses for improvements or special equipment added to your home can be reimbursed if the main purpose of the item is medical care. How much is reimbursed depends on the extent to which the expense permanently improves the property and whether others benefit.

The amount paid for the improvement is reduced by the increase in the value of your home or property. The difference between the cost of the improvement minus the increased value equals the eligible expense.

If the value of your home or property is not increased by the improvement, the entire cost is an eligible expense. Use the Capital Expense Worksheet to determine if your expense is eligible.

Examples of these expenses are:

  • Constructing entrance or exit ramps
  • Widening or otherwise modifying doorways, hallways and stairways
  • Installing railings, support bars, or other modifications to bathrooms
  • Kitchen modifications, including lowering cabinets and other equipment
  • Electrical and plumbing modifications
  • Exterior grading of the property to provide access to your home

This list is not exhaustive. If expenses are similar to those listed above, and are incurred to adapt a personal residence to yours or your spouse’s or dependent’s condition, the expenses are eligible subject to the terms noted above. Expenses must be reasonable, and directly related to the medical condition. Costs that are incurred for architectural or aesthetic reasons are not eligible.

Please refer to IRS Publication 502 for additional information, including operation and upkeep.

CHILDBIRTH CLASSES HCFSA X      
CHIROPRACTIC HCFSA X      
CHRISTIAN SCIENCE PRACTITIONERS HCFSA X     Payments for medical care can be reimbursed.
CIALIS HCFSA X      
CIRCUMCISION HCFSA X     A bris performed in the home by a Rabbi is not an eligible expense.
COBRA PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.
CO-INSURANCE HCFSA X     Cannot be reimbursed by secondary insurance or any other source.
COMPANION ANIMALS HCFSA   X   See SERVICE ANIMALS
COMPRESSION HOSE/SOCKS (includes diabetic socks) HCFSA X    
CONCIERGE MEDICAL CARE HCFSA   X The cost of joining such a program is not reimbursable such as monthly or annual fees.  However, actual care (i.e., physical exam, office visit, etc.) provided by physicians belonging to such programs would be covered when billed after such care is provided -- so long as it is not unreasonably expensive and so long as it has not and will not be reimbursed from other health plan coverage.
CONTACT LENSES HCFSA X      
CONTROLLED SUBSTANCES HCFSA   X
CO-PAYMENTS HCFSA X   Cannot be reimbursed by secondary insurance or any other source.
CORD BLOOD STORAGE HCFSA   X   Can be reimbursed if there is a specific medical condition that the cord blood is intended to treat. Indefinite storage “just in case” is not an eligible expense.
CORNEAL RING SEGMENTS HCFSA X      
COSMETIC PROCEDURES HCFSA   X   Cosmetic procedures to improve or enhance appearance are not eligible.

A cosmetic procedure or service necessary to improve a deformity arising from a congenital abnormality, personal injury from accident or trauma, or to restore appearance related to treatment for another medical diagnosis or condition can be reimbursed.
COUNSELING HCFSA X     If counseling is provided to treat a medical or mental diagnosis and is rendered by a licensed provider.

Eligible expenses include psychotherapy, bereavement and grief counseling, sex counseling, etc.

  HCFSA     X Life coaching, career counseling and marriage counseling do not qualify.
CROWNS HCFSA X     See DENTAL CARE
CRUTCHES HCFSA X      

*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. This letter must be submitted with every claim.

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D
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
DANCING LESSONS HCFSA   X   Only for a short duration and if prescribed for a specific medical condition, such as part of a rehabilitation program after surgery.
DEDUCTIBLES HCFSA X     Cannot be reimbursed by secondary insurance or any other source.
DENTAL MAINTENANCE ORGANIZATION (DMO) HCFSA     X See INSURANCE PREMIUMS
DENTAL CARE 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
  HCFSA     X Expenses for cosmetic dentistry, such as teeth whitening or bleaching, porcelain veneers, or bonding are not eligible for reimbursement.
DIABETIC SHOES HCFSA   X Won't qualify if used for personal or preventive reasons. If used to treat or alleviate a specific medical condition, only the excess cost of the specialized shoes over the cost of regular shoes will qualify.
To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required.
DIABETIC SUPPLIES HCFSA X      
DIAPER RASH CREAMS HCFSA   X   See OTC
DIAPERS, DIAPER SERVICE HCFSA     X Routine care of healthy newborn
  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.
DOCTOR FEES 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 HCFSA   X   If the doula is a licensed health care professional who renders medical care, his or her fees can be reimbursed.
DRUGS HCFSA       See CONTROLLED SUBSTANCES, PRESCRIPTION DRUGS and OTC
DRUG ADDICTION, treatment of 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, 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. This letter must be submitted with every claim.

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E
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
EAR PLUGS HCFSA   X   Must be prescribed to treat a specific medical condition, such as the presence of middle/inner ear tubes.
ELECTROLYSIS HCFSA     X  
ERGONOMIC ITEMS HCFSA X Requires a letter of medical necessity.  Reimbursement will be for the difference between the specialty item and the non specialty item.
EYEGLASSES HCFSA X     Includes prescription sunglasses and reading glasses (even those purchased over-the-counter).

Please note that product protection plans, or warranties, and clip-on sunglasses are not eligible for reimbursement.

*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. This letter must be submitted with every claim.

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F
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
FACE WASH, MEDICATED HCFSA X

Covered with a Letter of Medical Necessity for such medical conditions such as acne, rosacea, etc.  Also covered if the primary use of the product is for the treatment of acne, such as:

AcneZine

Murad Acne Complex

FACE WASH, NON MEDICATED HCFSA   X The cost of regular skin care is not covered as this is a toiletry. FERTILITY ENHANCEMENT HCFSA X     Includes ovulation predictor kits and pregnancy tests. FERTILITY TREATMENT HCFSA   X   Will qualify to the extent that procedures are intended to overcome an inability to have children due to medical reasons and are performed on you, your spouse or your dependent. FINANCE CHARGES HCFSA     X   FIRST AID KIT HCFSA   X   A letter of medical necessity is not required, but please see OTC. FITNESS PROGRAMS HCFSA   X   Fees paid for a fitness program may be an eligible expense if prescribed by a physician and substantiated by his or her statement that treatment is necessary to alleviate a medical problem. FLU SHOTS HCFSA X       FOOD HCFSA   X  

Food may be eligible if prescribed by a medical practitioner to treat a specific illness or ailment and if the food does not substitute for normal nutritional requirements. However, the amount that may qualify for reimbursement is limited to the amount by which the cost of the food exceeds the cost of commonly available versions of the same product.

FUNERAL EXPENSES HCFSA     X  

*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. This letter must be submitted with every claim.

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G
Condition/Type of Service/Expense HCFSA Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
GLUCOSAMINE CHONDROITIN HCFSA   X Will qualify if used primarily for medical care (for example, to treat arthritis). Won't qualify if used just to maintain general health. To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition (for example, arthritis) is normally required.
GUIDE DOGS HCFSA   X   See SERVICE ANIMALS
GIFT CARDS HCFSA     X Gift cards are not an eligible expense, even if these cards are provided by a medical provider such as an eye glass store or a pharmacy.

*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. This letter must be submitted with every claim.

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H
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
HAIR TRANSPLANT HCFSA     X  
HEALTH CLUBS/GYM MEMBERSHIPS HCFSA   X Requires a Letter of Medical Necessity and a statement from the individual stating "but for" the medical condition listed in the letter of medical necessity, he or she would not have joined the health club/gym.

You cannot be reimbursed for expenses that will be incurred in the future, even if payment is required in advance.   In addition, the fees no longer qualify when treatment is no longer needed.
HEALTH SCREENINGS HCFSA X     See PREVENTIVE CARE SCREENINGS
HEARING AIDS HCFSA X     Includes batteries
HOME MEDICAL EQUIPMENT HCFSA X      
HOMEOPATHIC CARE HCFSA X     Homeopathic care rendered by a licensed health care professional who provides this care for the treatment of a specific illness or disorder for you, your spouse or dependent can be reimbursed under a HCFSA.
HOMEOPATHIC MEDICINES HCFSA   X   Homeopathic medicines used for treatment of a specific illness or disorder can be reimbursed.
HOUSEHOLD HELP HCFSA     X  
HUMIDIFIERS HCFSA   X   See ALLERGY RELIEF, CAPITAL EXPENSES
HYDROTHERAPY HCFSA   X    
HYPNOSIS HCFSA X    

*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. This letter must be submitted with every claim.

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I
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
IMMUNIZATIONS HCFSA X     Includes those recommended for overseas travel
INSURANCE PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.

*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. This letter must be submitted with every claim.

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L
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
LAB FEES HCFSA X      
LACTATION CONSULTANT HCFSA   X   Services rendered by a licensed health care provider can be reimbursed.
LAMAZE CLASSES HCFSA X      
LASER EYE SURGERY HCFSA X     See VISION CARE
LEAD-BASED PAINT REMOVAL HCFSA X     Expenses for removing lead-based paints from surfaces in your home to prevent a child who has or has had lead poisoning from eating the paint can be reimbursed. These surfaces must be in poor repair and within a child’s reach.

The cost of repainting the affected area(s) is not an eligible expense. If you cover the area with wallboard or paneling instead of removing the lead paint, these items will be treated as capital expenses.

LEARNING DISABILITIES HCFSA   X   The portion of tuition/tutoring fees covering services rendered specifically for your child's severe learning disabilities caused by mental or physical impairments (such as nervous system disorders, or closed head injuries) and paid to a special school or to a specially-trained teacher may be reimbursed under a HCFSA if prescribed by a physician. Examples of eligible expenses include:
  • Remedial reading for your child or dependent with dyslexia
  • Testing to diagnose
LEGAL FEES HCFSA   X   Legal fees paid to authorize treatment for mental illness are eligible expenses.
LEVITRA HCFSA X      
LIFETIME CARE HCFSA     X Fees or advance payments made to a retirement home or continuing care facility are not eligible expenses.
LODGING HCFSA   X   Up to $50 per night is eligible if the following conditions are met:
  • The lodging is primarily for, and essential to, medical care
  • The medical care is provided by a doctor in a licensed hospital or medical care facility related to/equivalent to a licensed hospital
  • The lodging is not lavish or extravagant
  • There is no significant element of personal pleasure or leisure in the travel.
  HCFSA   X   Your companion’s lodging can be reimbursed if he or she is accompanying the patient (you or your eligible dependents) for medical reasons and it meets the criteria listed above. Meals are not eligible for reimbursement.

Example: Parents traveling with a sick child, up to $100 per night ($50 per person) may be reimbursed, as well as lodging and pre and post-hospitalization for bone marrow transplants.

  HCFSA   X   The cost of a special home or step-down facility for your mentally handicapped dependent, recommended by a psychiatrist to help your dependent adjust after inpatient mental health care to community living can be reimbursed.
LONG-TERM CARE INSURANCE PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a HCFSA.
LONG-TERM CARE SERVICES HCFSA     X Refer to Section 106(c) of the IRS Code for more information.

*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. This letter must be submitted with every claim.

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M
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
MASSAGE THERAPY HCFSA   X   Therapeutic Massage treating a specific medical condition can be reimbursed under a HCFSA. The words “therapy” or “therapeutic” must be included in the description of the service. Gratuities are not reimbursable.
MATERNITY HCFSA       See PREGNANCY AIDS
MATERNITY CLOTHES HCFSA     X  
MEALS HCFSA     X  
MEDICAL ALERT BRACELET HCFSA X      
MEDICAL INFORMATION HCFSA X     Amounts paid to a plan that maintains electronic medical information for you, your spouse or dependents are eligible for reimbursement under an HCFSA.
MEDICAL RECORDS HCFSA X     Costs associated with copying or transferring medical records to a new provider are eligible for reimbursement.
MEDICAL SAVINGS ACCOUNTS HCFSA     X  
MEDICAL SERVICES HCFSA X     Expenses for medical services prescribed by physicians or other health care providers acting within their scope of licensure can be reimbursed under a HCFSA.
MEDICAL SUPPLIES HCFSA X     Please refer to OTC Quick Reference Guide
MILEAGE EXPENSES HCFSA X  

To submit a claim for mileage expenses, please list the number of miles, the date of service and the dollar amount of the mileage expense you are claiming. The provider information should also be listed on the claim form.

Effective January 1, 2016 - The mileage rate will be changing from $.23 to $.19
MISSED APPOINTMENT FEES HCFSA     X  
MOUTHWASH HCFSA   X   T he mouthwash can only be obtained with a prescription and a letter of medical necessity is sent to ASI.

*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. This letter must be submitted with every claim.

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N
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
NATUROPATHIC CARE HCFSA   X   Naturopathic care rendered by a licensed health care professional who provides this care for the treatment of a specific illness or disorder for you, your spouse or dependent can be reimbursed under a HCFSA.
NON-COVERED SERVICES HCFSA X     Medical care or services that are not covered under your major medical plan may be reimbursed under an HCFSA.
NEWBORN NURSING CARE HCFSA     X Nursing services for a normal, healthy newborn are not an eligible expense.
NURSING CARE AND SERVICES (private duty nursing) HCFSA   X   Nursing services are an eligible expense, whether provided in your home or another facility. The nurse need not be an R.N. or L.P.N., so long as the services rendered are of a kind generally performed by a nurse. These include services directly related to caring for and monitoring your, your spouse’s or dependent’s condition, including:
  • Preparing and giving medication
  • Changing dressings and providing wound care
  • Monitoring vital signs
  • Assessing responses to prescribed treatments, and documenting those assessments in written notes

If the individual providing nursing services also provides household and personal services, only those charges related to actual nursing care are eligible expenses.

NURSING HOME HCFSA   X   Expenses for medical care in a nursing home for you, your spouse and dependent(s), including meals and lodging may be reimbursed if the main purpose of the stay is to receive medical care.

If the primary reason for confinement is personal (i.e., you or your spouse or dependent needs assistance with activities of daily living, safety issues, etc.), only the portion of the cost that is directly related to medical care or nursing services may be reimbursed.

NUTRITIONAL SUPPLEMENTS HCFSA   X   Dietary, nutritional, and herbal supplements, vitamins, and natural medicines are not reimbursable if they are merely beneficial for general health. However, they may be reimbursable if recommended by a medical practitioner to treat a specific medical condition.
NUTRITIONIST HCFSA   X   Nutritional services related to the treatment and guidance of a specific diagnosis or medical condition can be reimbursed.

*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. This letter must be submitted with every claim.

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O
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
OCCUPATIONAL THERAPY HCFSA X      
OPTOMETRIST HCFSA X      
ORTHODONTIA HCFSA X     You may seek reimbursement for orthodontia services through your FSA, as you pay for the services.

In order be reimbursed for these services, there are a few things to keep in mind:

1) The braces must have been placed (or the initial work provided) and must still be on the patient.

2) You must submit a copy of your treatment plan (sometimes called your contract) with your provider that lists the total amount for which you are responsible and the treatment period.

3) You must submit proof of payment with your reimbursement request. The proof of payment can be a paid receipt from your provider, a credit card receipt or your credit card statement.
ORTHOTIC INSERTS HCFSA X Both custom-made and over-the-counter inserts are eligible for reimbursement.
ORTHOPEDIC SHOES HCFSA   X Won't qualify if used for personal or preventive reasons. If used to treat or alleviate a specific medical condition, only the excess cost of the specialized orthopedic shoe over the cost of a regular shoe will qualify.
 *
To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required.
OSTEOPATH HCFSA X      
OVER-THE-COUNTER MEDICINES AND SUPPLIES
(Over-the-Counter medicines will require a prescription beginning January 1, 2011.  Please see the Home page for more information.)
HCFSA X   See OTC Quick Reference Guide for more details.

If eligible, claims must include a proper receipt.

A proper receipt must contain all of the following information:   1) name of the item or service; 2) the date of purchase or service; and 3) the amount paid.   Note for over-the-counter items:   If the receipt does not include this information, copy the label from the product or its packaging, circle the correct amount on the receipt, and submit this information with the signed claim form.

  HCFSA   X   Eligible dental or vision over-the-counter expenses, such as denture care products, and contact lens cleaning and soaking solutions may be reimbursed.
OVER-THE-COUNTER ITEMS AND SUPPLIES THAT ARE DUAL PURPOSE HCFSA   X   Dual purpose items (a product used to alleviate medical conditions but also used for general health) may be eligible but require a letter of medical necessity, only the difference in cost between the purchased item(s) and a similar non-specialty item and a proper receipt.

A proper receipt must contain all of the following information:  1) name of the item or service; 2) the date of purchase or service; and 3) the amount paid.  Note for over-the-counter items:  If the receipt does not include this information, copy the label from the product or its packaging, circle the correct amount on the receipt, and submit this information with the signed claim form.

OVULATION MONITOR HCFSA X      
OXYGEN HCFSA   X    

*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. This letter must be submitted with every claim.

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P
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
PARKING FEES AND TOLLS HCFSA X     See TRANSPORTATION
PATTERNING EXERCISES HCFSA   X   While these exercises are often done by family members, the expense to hire someone to perform patterning exercises is an eligible expense.
PENILE IMPLANTS HCFSA   X   Amounts paid for implants may be eligible if the diagnosis of impotence is due to organic causes, such as diabetes, post-prostatectomy complications, or spinal cord injury.
PERSONAL ITEMS HCFSA     X  
PHYSICAL THERAPY HCFSA X      
PREGNANCY AIDS HCFSA X     Items that relieve or reduce the discomfort of pregnancy may be reimbursed under a HCFSA. Examples include:
  • Maternity girdles
  • Elastic hosiery
  • Maternity support belts
PREGNANCY TESTS HCFSA X     See OTC
PRESCRIPTION DRUG DISCOUNT PROGRAM HCFSA     X Fees paid to get access to drugs at a reduced cost are not eligible for reimbursement under a HCFSA. Actual costs paid for prescription drugs are an eligible expense.
PRESCRIPTION DRUGS HCFSA X     Eligible expenses include deductibles, co-payments or co-insurance as well as the costs for prescription drugs that may not be covered under your medical insurance, such as drugs that treat erectile dysfunction.
PRESCRIPTION DRUGS - IMPORTED HCFSA     X IRS regulations state that any drug imported into the United States by a consumer is not eligible for reimbursement under an FSA.
PREVENTIVE CARE SCREENINGS HCFSA X     If the tests are designed to assess symptoms of a medical diagnosis, they are eligible for reimbursement. Examples include clinic and home testing kits for blood pressure, glaucoma, cataracts, hearing, cholesterol, etc.
PROSTHETICS HCFSA X      
PSYCHIATRIC SERVICES AND CARE HCFSA X      
PSYCHOANALYSIS HCFSA X      
PSYCHOLOGIST HCFSA X      

*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. This letter must be submitted with every claim.

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R
Condition/Type of Service/Expense HCFSA Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
RADON MITIGATION HCFSA X     If a physician requires radon mitigation in your home due to a medical condition caused or aggravated by an unacceptable level of radon, some expenses may be eligible. However, if the home’s value is increased due to the mitigation, some or all of the expenses may not be reimbursable. Use the Capital Expense Worksheet to determine how much of the expense is eligible.
READING GLASSES HCFSA X     See EYEGLASSES
REFLEXOLOGY HCFSA   X    
RETIN-A HCFSA       See OTC Quick Reference Guide
ROGAINE HCFSA       See OTC Quick Reference Guide

*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. This letter must be submitted with every claim.

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S
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
SALES TAX HCFSA       See TAXES
SERVICE ANIMALS HCFSA   X   Expenses to train or procure any guide dog, signal dog, or other animal individually trained to provide assistance to you, your spouse or dependent with a disability can be reimbursed under a HCFSA.
SHIPPING AND HANDLING HCFSA X     Shipping and handling charges for medical needs, such as mail-order prescriptions.
SMOKING CESSATION PROGRAMS HCFSA X      
SMOKING CESSATION PRODUCTS HCFSA   X Products such as nicotine gum and patches will require a prescription from a medical doctor before being eligible.
SONICARE TOOTHBRUSHES
*See Toothbrush
HCFSA     X Won't qualify even if a dentist recommends special ones (such as electric or battery-powered) to treat a medical condition like gingivitis. Toothbrushes are items that are used primarily to maintain general health—a person would still use one even without the medical condition. Thus, they are not primarily for medical care
SPECIAL EDUCATION AND SCHOOLS HCFSA   X   See LEARNING DISABILITIES
SPECIAL FOODS HCFSA   X   If prescribed by a physician to treat a special illness or ailment, and not merely as a substitute for normal nutritional requirements.

The amount that can be reimbursed is limited to the amount that the special food exceeds the cost of commonly available versions of the same product.

SPECIALIZED EQUIPMENT OR SERVICES HCFSA       See ADAPTIVE EQUIPMENT
SPEECH THERAPY HCFSA X      
SPERM STORAGE HCFSA   X   Storage fees can be reimbursed if you, your spouse or dependent has a cancer or blood dyscrasia diagnosis that requires chemotherapy or whole body radiation which may affect future ability to conceive children.
STERILIZATION PROCEDURES HCFSA X      
STERILIZATION REVERSAL HCFSA X      
STUDENT HEALTH FEE HCFSA     X  
SUBSTANCE ABUSE HCFSA X     See ALCOHOLISM
SUNBURN CREAMS AND OINTMENTS, MEDICATED HCFSA   X Will qualify if used to treat a sunburn (and not as regular skin moisturizers), but must be prescribed if incurred after December 31, 2010.
SUN-PROTECTIVE CLOTHING HCFSA   X   Won’t qualify if used to maintain general health or for other personal reasons. May qualify if used to treat or alleviate a specific medical condition (e.g., melanoma) and if the expense would not have been incurred “but for” the condition, but only the excess cost of the specialized garment over the cost of ordinary clothing will qualify. To show that the expense is primarily for medical care, a note from a medical practitioner recommending the item to treat a specific medical condition is normally required.
SUNSCREEN HCFSA X      

*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. This letter must be submitted with every claim.

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T
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
TANNING SALON OR EQUIPMENT HCFSA     X No, if just to improve general health or appearance.
  HCFSA   X   May be reimbursed under a HCFSA for treatment of certain skin disorders, such as eczema and psoriasis.
TAXES HCFSA X   Taxes on medical services and products may be reimbursed under a HCFSA. This includes local, state, service and other taxes.
TEETH WHITENING HCFSA     X Teeth whitening products or services to enhance the brightness of your teeth are cosmetic and cannot be reimbursed.
TELEPHONE FOR HEARING IMPAIRED HCFSA X     Expenses associated with purchasing or repairing special telephone equipment for you, your spouse or dependent with a hearing impairment are eligible for reimbursement under a HCFSA.
TELEVISION HCFSA   X   Expenses for equipment that displays the audio of television programming as subtitles for hearing impaired persons are eligible for reimbursement under a HCFSA.

The eligible expense is limited to the cost that exceeds the cost of a non-adapted set.

See CAPITAL EXPENSES.

TEMPORARY CONTINUATION OF COVERAGE (TCC) PREMIUMS HCFSA X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.
TOOTHBRUSH HCFSA   X Won't qualify even if a dentist recommends special ones (such as electric or battery-powered) to treat a medical condition like gingivitis. Toothbrushes are items that are used primarily to maintain general health—a person would still use one even without the medical condition. Thus, they are not primarily for medical care
TOOTHPASTE HCFSA   X Won't qualify even if a dentist recommends a special one to treat a medical condition like gingivitis. Toothpaste is an item that is primarily used to maintain general health—a person would still use it even without the medical condition. Thus, it is not primarily for medical care. But topical creams or other drugs (e.g., fluoride treatment) used to treat a dental condition would qualify, so long as they are primarily for medical care.
TRANSPORTATION HCFSA X

Car mileage, bus, taxi, and subway or train fare for travel to and from receiving medical care, including health care providers, hospitals and pharmacies can be reimbursed.

Mileage incurred traveling to and from your medical provider is reimbursable through the HCFSA.

To ensure your transportation claim is approved, be sure to submit your receipt(s) or an itemization of your travel with the claim that coincides with the service(s) rendered.

  HCFSA   X   Plane fare must not be merely for convenience.
  HCFSA   X   In some cases, transportation expenses of the following persons may be reimbursed:
  • A parent who must go with a child who needs medical care
  • A nurse or other person who can give injections, medications or other treatment required by a patient traveling to get medical care and who is unable to travel alone
  • Visits to see your mentally ill dependent, if part of a treatment plan
TRICARE PREMIUMS HCFSA     X Under IRS rules, insurance premiums cannot be reimbursed under a health care FSA.
TRIPS HCFSA     X Excursions taken for a change in environment, general health improvement etc., even those taken on the advice of your health care provider are not an eligible expense.

*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. This letter must be submitted with every claim.

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U
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
UCR, CHARGES ABOVE HCFSA X     Medical expenses in excess of your plan’s usual, customary and reasonable (UCR) charges may be reimbursed under a HCFSA if the underlying expense is eligible.
ULTRASOUND, PRE-NATAL HCFSA   X   An ultrasound ordered by your physician to monitor fetal growth, and/or to diagnose, treat or monitor a pregnancy-related condition is a covered expense under your HCFSA, even if your health plan does not provide reimbursement. An ultrasound not ordered or performed by a physician or other licensed professional, and/or not intended to diagnose, treat or monitor a pregnancy-related condition is not an eligible expense.

*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. This letter must be submitted with every claim.

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V
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
VASECTOMY HCFSA X      
VASECTOMY REVERSAL HCFSA X     See STERILIZATION REVERSAL
VIAGRA HCFSA X      
VISION CARE HCFSA X      
VISION DISCOUNT PROGRAMS HCFSA     X Fees paid to gain access to a vision network, or to a reduced fee structure are not an eligible expense under a HCFSA.

See INSURANCE PREMIUMS

VITAMINS HCFSA   X   See OTC

*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. This letter must be submitted with every claim.

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W
Condition/Type of Service/Expense Account Type Eligible
Expense
Potentially
Eligible
Expense*
Not
Eligible
Additional Information
WALKERS HCFSA X      
WATER FLUORIDATION HCFSA   X    
WEIGHT LOSS PROGRAMS HCFSA   X Cannot include the cost of diet food or beverages in medical expenses because the diet food and beverages substitute for what is normally consumed to satisfy nutritional needs.
WELL-BABY/WELL-CHILD CARE HCFSA X      
WHIRLPOOL BATHS HCFSA   X    
WHEELCHAIRS HCFSA X      
WIG HCFSA   X   The full cost of a wig purchased because the patient has lost all of his or her hair from disease or treatment.

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Eligible expenses listed here are subject to change without notice.