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HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex.CONTACT PAYFLEX
Start here to connect with us. Complete the form below to connect with a PayFlex sales representative and we'll be in touch with you soon. If you're an employee looking for help with your PayFlex account, just log in and go to Help & Support.You’ll find FAQs, an email tool, live chat and our customer service number. HEALTH CARE FLEXIBLE SPENDING ACCOUNTS (FSAS) Health Care Flexible Spending Accounts (FSAs) let employees set aside money from their paycheck before taxes to use for certain eligible expenses. Employers end up saving on taxes too, all while earning goodwill. Learn more about the benefits of health care FSAs fromPayFlex.
HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | ADP
Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellness PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescription COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex.MEMBER LOGIN
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HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex.CONTACT PAYFLEX
Start here to connect with us. Complete the form below to connect with a PayFlex sales representative and we'll be in touch with you soon. If you're an employee looking for help with your PayFlex account, just log in and go to Help & Support.You’ll find FAQs, an email tool, live chat and our customer service number. HEALTH CARE FLEXIBLE SPENDING ACCOUNTS (FSAS) Health Care Flexible Spending Accounts (FSAs) let employees set aside money from their paycheck before taxes to use for certain eligible expenses. Employers end up saving on taxes too, all while earning goodwill. Learn more about the benefits of health care FSAs fromPayFlex.
HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | ADP
Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969.INDIVIDUALS
With PayFlex, you have the control and flexibility to plan, save and pay for your personal well-being, and it’s easier than ever. Learn more about all the pretax accounts PayFlex offers employees and how they can help you save on products and services you’re already spending money on, and more. PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescriptionWELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. FLEXIBLE SPENDING ACCOUNTS (FSAS) FOR INDIVIDUALS With health care Flexible Spending Accounts, you can save on everyday items like contact lenses, sunscreen and bandages. Or those high dollar expenses like surgery, orthodontia, and hearing aids. You choose from a list of eligible expenses. Learn more about the benefits of an FSA with PayFlex. COBRA & DIRECT BILLING ADMINISTRATION FOR EMPLOYERS PayFlex makes it simple for your employees to enroll in COBRA and make premium payments. For retirees or employees on leave, they need a way to continue coverage and make premium payments – PayFlex’s Direct Billing service can help. Learn more aboutCAREERS | PAYFLEX
If you’re thinking about joining the PayFlex team, know that we’ll support you with generous benefits - from health care to work-life balance, we’ve got you covered. We’re a team with a passion for personal well-being and that applies not just to our customers, but to you, too. Learn more about jobs and careers at PayFlex. HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA).) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. ) RECURRING PREMIUM REIMBURSEMENT CLAIM FORM (Last Name, First, MI) End of Policy Health Reimbursement Arrangement (HRA)/ Retiree Reimbursement Arrangement (RRA) Recurring Premium Reimbursement Claim Form PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellness PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescription COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex.MEMBER LOGIN
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HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex.CONTACT PAYFLEX
Start here to connect with us. Complete the form below to connect with a PayFlex sales representative and we'll be in touch with you soon. If you're an employee looking for help with your PayFlex account, just log in and go to Help & Support.You’ll find FAQs, an email tool, live chat and our customer service number. HEALTH CARE FLEXIBLE SPENDING ACCOUNTS (FSAS) Health Care Flexible Spending Accounts (FSAs) let employees set aside money from their paycheck before taxes to use for certain eligible expenses. Employers end up saving on taxes too, all while earning goodwill. Learn more about the benefits of health care FSAs fromPayFlex.
HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | ADP
Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellness PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescription COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex.MEMBER LOGIN
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HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex.CONTACT PAYFLEX
Start here to connect with us. Complete the form below to connect with a PayFlex sales representative and we'll be in touch with you soon. If you're an employee looking for help with your PayFlex account, just log in and go to Help & Support.You’ll find FAQs, an email tool, live chat and our customer service number. HEALTH CARE FLEXIBLE SPENDING ACCOUNTS (FSAS) Health Care Flexible Spending Accounts (FSAs) let employees set aside money from their paycheck before taxes to use for certain eligible expenses. Employers end up saving on taxes too, all while earning goodwill. Learn more about the benefits of health care FSAs fromPayFlex.
HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | ADP
Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969.INDIVIDUALS
With PayFlex, you have the control and flexibility to plan, save and pay for your personal well-being, and it’s easier than ever. Learn more about all the pretax accounts PayFlex offers employees and how they can help you save on products and services you’re already spending money on, and more. PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescriptionWELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. FLEXIBLE SPENDING ACCOUNTS (FSAS) FOR INDIVIDUALS With health care Flexible Spending Accounts, you can save on everyday items like contact lenses, sunscreen and bandages. Or those high dollar expenses like surgery, orthodontia, and hearing aids. You choose from a list of eligible expenses. Learn more about the benefits of an FSA with PayFlex. COBRA & DIRECT BILLING ADMINISTRATION FOR EMPLOYERS PayFlex makes it simple for your employees to enroll in COBRA and make premium payments. For retirees or employees on leave, they need a way to continue coverage and make premium payments – PayFlex’s Direct Billing service can help. Learn more about HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA).CAREERS | PAYFLEX
If you’re thinking about joining the PayFlex team, know that we’ll support you with generous benefits - from health care to work-life balance, we’ve got you covered. We’re a team with a passion for personal well-being and that applies not just to our customers, but to you, too. Learn more about jobs and careers at PayFlex.HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969.) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
) RECURRING PREMIUM REIMBURSEMENT CLAIM FORM (Last Name, First, MI) End of Policy Health Reimbursement Arrangement (HRA)/ Retiree Reimbursement Arrangement (RRA) Recurring Premium Reimbursement Claim Form PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellnessMEMBER LOGIN
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PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescription COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex. PAYFLEX INDIVIDUAL HEALTH SAVINGS ACCOUNT (HSA) A health savings account (HSA) pairs well with an HDHP because you can use it to help cover your deductible. Once you pay the deductible, the health plan can pay a portion of your claims. A qualified HDHP must meet the following criteria. For 2021, it must have a minimum deductible amount of at least $1,400 for a self-only/individual planor
WELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA).HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
) RECURRING PREMIUM REIMBURSEMENT CLAIM FORM (Last Name, First, MI) End of Policy Health Reimbursement Arrangement (HRA)/ Retiree Reimbursement Arrangement (RRA) Recurring Premium Reimbursement Claim Form PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellnessMEMBER LOGIN
We’re sorry. You’re unable to log in at this time. Please tryagain later.
PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescription COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex. PAYFLEX INDIVIDUAL HEALTH SAVINGS ACCOUNT (HSA) A health savings account (HSA) pairs well with an HDHP because you can use it to help cover your deductible. Once you pay the deductible, the health plan can pay a portion of your claims. A qualified HDHP must meet the following criteria. For 2021, it must have a minimum deductible amount of at least $1,400 for a self-only/individual planor
WELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA).HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
) RECURRING PREMIUM REIMBURSEMENT CLAIM FORM (Last Name, First, MI) End of Policy Health Reimbursement Arrangement (HRA)/ Retiree Reimbursement Arrangement (RRA) Recurring Premium Reimbursement Claim Form PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescriptionWELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex. HEALTH CARE FLEXIBLE SPENDING ACCOUNTS (FSAS) Health Care Flexible Spending Accounts (FSAs) let employees set aside money from their paycheck before taxes to use for certain eligible expenses. Employers end up saving on taxes too, all while earning goodwill. Learn more about the benefits of health care FSAs fromPayFlex.
DEPENDENT CARE FSAS FOR INDIVIDUALS Like other FSAs, the dependent care Flexible Spending Account allows you to fund an account with pretax dollars, but this account is for eligible child and adult care expenses including preschool, nursery school, day care, before and after school care and summer day camp. Learn more about the benefits of a dependent care FSA with PayFlex. FREQUENTLY ASKED QUESTIONS FOR MEMBERS Frequently Asked Questions (FAQs) Check out these FAQs to learn more about COVID-19 and how it may impact your PayFlex account(s). For more specific account updates, log in to the PayFlex member website.You can also follow us on Facebook and LinkedIn.) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
INVESTING WITH YOUR PAYFLEX® HEALTH SAVINGS ACCOUNT (HSA) If you’re a PayFlex HSA member, you have the opportunity to grow your HSA balance. How? By investing in a variety of mutual funds. There aren’t many accounts where you can make tax-free contributionsand
HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. PAYFLEX® HEALTH SAVINGS ACCOUNT (HSA) www.PayFlex.com ©2018 PayFlex Systems USA, Inc. 69.03.617.1 L (9/18) — Horace Mann. Note: There may be fees associated with a Health Savings Account (“HSA”). PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellnessMEMBER LOGIN
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COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex. PAYFLEX INDIVIDUAL HEALTH SAVINGS ACCOUNT (HSA) A health savings account (HSA) pairs well with an HDHP because you can use it to help cover your deductible. Once you pay the deductible, the health plan can pay a portion of your claims. A qualified HDHP must meet the following criteria. For 2021, it must have a minimum deductible amount of at least $1,400 for a self-only/individual planor
WELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA). FREQUENTLY ASKED QUESTIONS FOR MEMBERS Frequently Asked Questions (FAQs) Check out these FAQs to learn more about COVID-19 and how it may impact your PayFlex account(s). For more specific account updates, log in to the PayFlex member website.You can also follow us on Facebook and LinkedIn.HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | ADP
Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
PRETAX ACCOUNTS & BENEFITS footnote 1 Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members.. footnote 2 You’ll want to add up your total health care expenses per year. These may include: Medical: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellnessMEMBER LOGIN
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COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex. PAYFLEX INDIVIDUAL HEALTH SAVINGS ACCOUNT (HSA) A health savings account (HSA) pairs well with an HDHP because you can use it to help cover your deductible. Once you pay the deductible, the health plan can pay a portion of your claims. A qualified HDHP must meet the following criteria. For 2021, it must have a minimum deductible amount of at least $1,400 for a self-only/individual planor
WELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA). FREQUENTLY ASKED QUESTIONS FOR MEMBERS Frequently Asked Questions (FAQs) Check out these FAQs to learn more about COVID-19 and how it may impact your PayFlex account(s). For more specific account updates, log in to the PayFlex member website.You can also follow us on Facebook and LinkedIn.HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | ADP
Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex. HEALTH CARE FLEXIBLE SPENDING ACCOUNTS (FSAS) Health Care Flexible Spending Accounts (FSAs) let employees set aside money from their paycheck before taxes to use for certain eligible expenses. Employers end up saving on taxes too, all while earning goodwill. Learn more about the benefits of health care FSAs fromPayFlex.
FREQUENTLY ASKED QUESTIONS FOR MEMBERS Frequently Asked Questions (FAQs) Check out these FAQs to learn more about COVID-19 and how it may impact your PayFlex account(s). For more specific account updates, log in to the PayFlex member website.You can also follow us on Facebook and LinkedIn. DEPENDENT CARE FSAS FOR INDIVIDUALS Like other FSAs, the dependent care Flexible Spending Account allows you to fund an account with pretax dollars, but this account is for eligible child and adult care expenses including preschool, nursery school, day care, before and after school care and summer day camp. Learn more about the benefits of a dependent care FSA with PayFlex.) CLAIM FORM
Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. INVESTING WITH YOUR PAYFLEX® HEALTH SAVINGS ACCOUNT (HSA) If you’re a PayFlex HSA member, you have the opportunity to grow your HSA balance. How? By investing in a variety of mutual funds. There aren’t many accounts where you can make tax-free contributionsand
AN EMPLOYER’S GUIDE TO THE HEALTH SAVINGS ACCOUNT (HSA) payflex.com . Page 3 . Proprietary. PayFlex ® HSA Road Rules | 2020/2021 Limits Publisher’s Note . Recognized as a valuable resource by millions of Americans since 2004, HSA Road Rules is aneasy-to
QUICK REFERENCE GUIDE COBRA Quick Reference Guide The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that provides you, your spouse and your tax dependents with the right to continue group healthbenefits on a
PAYFLEX® HEALTH SAVINGS ACCOUNT (HSA) www.PayFlex.com ©2018 PayFlex Systems USA, Inc. 69.03.617.1 L (9/18) — Horace Mann. Note: There may be fees associated with a Health Savings Account (“HSA”). PRETAX ACCOUNTS & BENEFITS footnote. 2. footnote. † For best estimate, enter an amount less than or equal to the pretax contribution limit: Health Care FSA: $2,750; HSA: $3,600 (individual coverage) and $7,200 (family coverage); Age 55 or older: You may contribute an additional $1,000 toyour HSA.
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With PayFlex, you have the control and flexibility to plan, save and pay for your personal well-being, and it’s easier than ever. Learn more about all the pretax accounts PayFlex offers employees and how they can help you save on products and services you’re already spending money on, and more. COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex. PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescriptionMEMBER LOGIN
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WELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex.HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. HOME | ADPFLEX DIRECT ADPMYSPENDINGACCOUNT ADP SIGN INFLEXDIRECT ADP CLAIM FORMMYSPENDINGACCOUNT WAGEWORKS ADP SIGN IN Sign in to get started. You can use this site to make payments, submit claims, and check on account activity. PRETAX ACCOUNTS & BENEFITS footnote. 2. footnote. † For best estimate, enter an amount less than or equal to the pretax contribution limit: Health Care FSA: $2,750; HSA: $3,600 (individual coverage) and $7,200 (family coverage); Age 55 or older: You may contribute an additional $1,000 toyour HSA.
INDIVIDUALS
With PayFlex, you have the control and flexibility to plan, save and pay for your personal well-being, and it’s easier than ever. Learn more about all the pretax accounts PayFlex offers employees and how they can help you save on products and services you’re already spending money on, and more. COBRA & DIRECT BILLING FOR INDIVIDUALS With PayFlex, you can enroll in COBRA and pay for your premium directly from your personal bank account, all online through our website. Direct Billing makes it easy to pay for insurance premiums too. It’s usually for retirees, employees out on disability and those taking a leave of absence. Learn more about after-employment benefits with PayFlex. PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescriptionMEMBER LOGIN
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WELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go. HEALTH SAVINGS ACCOUNTS (HSAS) Health Savings Accounts can help you save and pay for eligible health care expenses. It’s like a 401k for health care. Contributions, earnings and withdrawals are all tax free. Learn more about the benefits of an HSA from PayFlex.HOME | CVS HEALTH
Additional relief for FSA plans. View details for the 6/1/2020 – 5/31/2021 plan year. Will CVS Health increase the dependent care FSA contribution limit for the 2021 plan year? For the June 1, 2021 - May 31, 2022 plan year, the DCFSA contribution limit will remain at $5,000 (or $2,500 if married and filing separately). Learn more about thelimit.
HOME | RETIREE
IRS Resources. Link to PDF. Medical and Dental Expenses - IRS Publication 502. Link to PDF. Health Savings Accounts and Other Tax-Favored Health Plans - IRS Publication 969. HOME | ADPFLEX DIRECT ADPMYSPENDINGACCOUNT ADP SIGN INFLEXDIRECT ADP CLAIM FORMMYSPENDINGACCOUNT WAGEWORKS ADP SIGN IN Sign in to get started. You can use this site to make payments, submit claims, and check on account activity.INDIVIDUALS
With PayFlex, you have the control and flexibility to plan, save and pay for your personal well-being, and it’s easier than ever. Learn more about all the pretax accounts PayFlex offers employees and how they can help you save on products and services you’re already spending money on, and more. PAYFLEX MOBILE® APP & PAYFLEX CARD® The PayFlex Card is your account debit card. It helps make it easier for you to spend the money in your PayFlex account. You can use this card to pay for certain eligible expenses. Eligible expenses may include doctor and dentist visits, hospital stays, prescriptions, and hearing and/or vision care. Or your plan may only allow prescriptionWELCOME | PAYFLEX
A simple dashboard. We give you control and flexibility to manage. the money in your tax advantaged accounts. We’ve made viewing your balance, filing a claim and. accessing your funds even easier. Your account in your hands. Take PayFlex with you wherever you go.CONTACT PAYFLEX
Start here to connect with us. Complete the form below to connect with a PayFlex sales representative and we'll be in touch with you soon. If you're an employee looking for help with your PayFlex account, just log in and go to Help & Support.You’ll find FAQs, an email tool, live chat and our customer service number. COBRA & DIRECT BILLING ADMINISTRATION FOR EMPLOYERS PayFlex makes it simple for your employees to enroll in COBRA and make premium payments. For retirees or employees on leave, they need a way to continue coverage and make premium payments – PayFlex’s Direct Billing service can help. Learn more about FLEXIBLE SPENDING ACCOUNTS (FSAS) FOR INDIVIDUALS With health care Flexible Spending Accounts, you can save on everyday items like contact lenses, sunscreen and bandages. Or those high dollar expenses like surgery, orthodontia, and hearing aids. You choose from a list of eligible expenses. Learn more about the benefits of an FSA with PayFlex. HEALTH REIMBURSEMENT ARRANGEMENTS/ACCOUNTS (HRAS) FOR An HRA is a health care account that only your employer can fund. You can use these funds to pay for eligible health care expenses. Your employer determines what’s eligible. Some employers may offer other types of HRAs, like a limited HRA, individual coverage HRA or a retiree reimbursement account (RRA). DEPENDENT CARE FSAS FOR INDIVIDUALS Like other FSAs, the dependent care Flexible Spending Account allows you to fund an account with pretax dollars, but this account is for eligible child and adult care expenses including preschool, nursery school, day care, before and after school care and summer day camp. Learn more about the benefits of a dependent care FSA with PayFlex. CONTACT US – ABOUT US PayFlex Advocates are here to help answer your questions about the accounts we offer. You can call us before, during, and after youenroll.
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Flexible Spending Account (FSA) / Limited Purpose Flexible Spending Account (LPFSA) Claim Form Mail or Fax completed form anddocumentation to:
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UNIQUELY PERSONAL BENEFITS SOLUTIONSWHO ARE YOU?
AN INDIVIDUAL ANEMPLOYER/BROKER
INDIVIDUALS • EMPLOYERS / BROKERSWHY CHOOSE PAYFLEX
It’s never been easier to plan, save, and pay for personal well-being. With PayFlex, you get more value — plus savings, simplicity and convenience.PLAN
Our tools can help you decide how much to contribute and estimate your savings. And for health savings accounts (HSAs), you can see the powerof investing.
SAVE
Your accounts don’t just provide tax savings. You can also get exclusive discounts on many health care items through CVS Pharmacy® online, in the app or in the store.footnote1PAY
At PayFlex, we go beyond traditional health care accounts. Employer-sponsored incentives and rewards help boost household budgets with more ways to pay for eligible products and services.INDIVIDUALS
ADD UP YOUR TAX SAVINGS Curious about how much you might save with a PayFlex health care account? Just plug in your numbers. This calculator will show you possible tax savings on eligible out-of-pocket expensesfootnote2. Total yearly eligible health care expensesAverage tax rate
21%
CLEAR
CALCULATE
Potential tax savings3 footnote†For best estimate, enter an amount less than or equal to the pretax contribution limit: HEALTH CARE FSA: $2,750; HSA: $3,550 (individual coverage) and $7,100 (family coverage); AGE 55 OR OLDER: You may contribute an additional $1,000 to your HSA. COMMON ELIGIBLE HEALTH CARE EXPENSES TAX-FREE SPENDING ON ELIGIBLE HEALTH CARE EXPENSES Check out the list of common eligible health care expenses. Use the search bar to find specific items and services. Or you can click on the column headers in the table to see which are eligible, eligible with a Letter of Medical Necessity (LOMN), or not eligible. FIND OUT IF AN EXPENSE IS ELIGIBLE SEARCH FOR A SPECIFIC ITEM OR SERVICE * Abdominoplasty (for cosmetic reasons) * Abdominoplasty (for medical condition) * Acne (over-the-counter item) * Acne (routine skin care)* Acne (services)
* Acupressure
* Acupuncture
* Adaptive Equipment * Adoption Medical Expenses (for tax qualified dependents) * Adoption Medical Expenses (incurred before adoption negotiations) * Adoption Medical Expenses (incurred by birth mother, associatedwith birth)
* Air Conditioner, Air Filter, Air Purifier * Air Fare (primarily for medical care) * Alcoholism, Drug Addiction Treatment* Allergy Medicine
* Allergy Products (used even without allergies) * Allergy Treatment Products (required for medical condition) * Alopecia Treatment * Alternative Healers * Alternative Medicine, Alternative Healers (for general health) * Alternative Medicine, Alternative Healers (for medical condition)* Ambulance Service
* Analgesics (painkillers), Antipyretics (fever reducers)* Anesthesiology
* Antacids, Acid Reducers * Antibiotics, topical* Anti-Diarrhea
* Anti-Embolism Socks, Stockings* Anti-Fungal
* Anti-Gas
* Antihistamines
* Anti-Itch
* Appearance Improvement * Arch and Insole Support* Arthritis Care
* Artificial Eye, Limb, Teeth * Artificial Insemination (active attempt to conceive) * Artificial Reproductive Technologies (active attempt to conceive)* Aspirin
* Assisted Living Facility * Asthma Equipment and Treatment * Asthma Equipment and Treatment (over-the-counter products) * Autoette (wheelchair) * Automated External Defibrillator (AED) * Automobile Modifications (cost of operating the car) * Automobile Modifications (for medical condition) * Automobile Modifications (specially designed car to hold awheelchair)
* Autopsy
* Baby Formula
* Babysitting, Child and Dependent Care (for healthy child)* Back Brace
* Baldness Treatment (for cosmetic reasons) * Baldness Treatment (for medical condition) * Bandages, Band-Aids* Bariatric Surgery
* Bariatric Surgery (for cosmetic reasons) * Bariatric Surgery (for obesity treatment) * Bedside Commode, Toilet (for medical reasons) * Behavioral Modification Programs * Bio-identical Hormone Replacement Therapy (for medical condition) * Bio-identical Hormone Replacement Therapy (used as an enhancement) * Birth Control (over-the-counter) * Birth Control (prescription) * Birthing Classes (not related to the actual childbirth) * Birthing Classes (related to childbirth)* Birthing Coach
* Bleaching or Whitening Teeth * Blepharoplasty (for cosmetic reasons) * Blepharoplasty (for medical condition)* Blood Donor Fee
* Blood Pressure Monitor* Blood Storage
* Blood Sugar Test Kits and Strips * Body Restoration Technique* Body Scan
* Botox Injections (for cosmetic reasons) * Botox Injections (for medical condition) * Boutique, Concierge, Practice Fees * Bracanalysis Testing * Braces, Orthodontia * Braille Books and Magazines * Breast Augmentation (for cosmetic reasons) * Breast Implants or Removal (for cosmetic reasons) * Breast Implants or Removal (for medical condition) * Breast Pump Purchase or Rental * Breast Reconstruction Surgery * Breast Reduction (for cosmetic reasons) * Breast Reduction (for medical condition) * Breastfeeding Supplies* Breathalyzer
* Bus Fare (primarily for medical care) * Calcium (for general health) * Calcium (for medical condition) * Capital Expense (cost of installing equipment in home) * Car Modification (cost of operating the car) * Car Modification (for medical condition) * Car Modification (specially designed car to hold a wheelchair) * Car Rental (primarily for medical care) * Carpal Tunnel Wrist Supports, Braces* Cervical Pillow
* Chairs, Reclining
* Chelation Therapy
* Chemical Peel (for cosmetic reasons)* Childbirth
* Childbirth Classes/Lamaze (not related to the actual childbirth) * Childbirth Classes/Lamaze (related to childbirth) * Chinese Herbal Practioner and Herbal Treatments (for generalhealth)
* Chinese Herbal Practitioner* Chiropody
* Chiropractor
* Cholesterol Testing * Christian Science Practitioners * Christian Science Treatments (for general health)* Circumcision
* Clinic
* Club Dues and Fees (for general health/non-medical) * Club Dues and Fees (for medical condition) * COBRA Premiums (if you have a health care FSA) * COBRA Premiums (If you have an HSA)* Co-Insurance
* Cold and Hot Packs (for medical purposes) * Cold and Hot Packs (for non-medical use)* Cold Medicines
* Cold Sore and Fever Blister Treatments (lip balm SPF 15 or higher) * Cold Sore and Fever Blister Treatments (lip balm SPF lower than 15) * Cold Sore and Fever Blister Treatments (over-the-counter) * Collagen Injections (for cosmetic reasons) * Collagen Injections (for medical condition) * Colon Therapy, Colon Hydrotherapy, Colonics* Companion Animal
* Compression Socks, Stockings * Concierge Medicine* Condoms
* Contact Lens Service Agreement and Warranty * Contact Lenses and Supplies (for cosmetic reasons) * Contact Lenses and Supplies (for vision correction) * Contact Lenses and Supplies (over-the-counter products) * Continuous Positive Airway Pressure (CPAP)* Contraceptives
* Controlled Substances * Convalescent Home (custodial care) * Convalescent Home (medical care, meals & lodging)* Copayment (copay)
* Cord Blood (harvesting/storage for medical condition) * Cord Blood (harvesting/storage for non-medical reasons)* Corneal Molding
* Corneal Ring Segments * Cosmetic Treatment (for medical condition) * Cosmetic Treatment (for non-medical reasons) * Cough Suppressants * Counseling (for medical condition) * Counseling (marriage/family for non-medical reasons)* CPR
* Crania-Sacral Therapy* Crown, dental
* Crutches
* Crystalens
* Dance Lessons (for medical condition) * Dance Lessons (non-medical)* Decongestant
* Deductibles
* Defibrillator
* Dehumidifier
* Dehydration Treatment * Dental Emergency Kit * Dental Maintenance Organization (DMO) Fees (if you have a healthcare FSA)
* Dental Maintenance Organization (DMO) Fees (if you have an HSA) * Dental Treatment (non-cosmetic) * Dental Treatment (oral hygiene & supplies) * Dental Treatment (over-the-counter flouride) * Dental Treatment (tooth bonding)* Dental, cosmetic
* Denture Adhesive
* Denture Cleanser
* Dentures (for cosmetic reasons) * Dentures (non-cosmetic)* Denturist
* Dependent Care (for disabled person) * Dependent Care (for healthy child) * Dermabrasion (for cosmetic reasons) * Dermatology (for cosmetic reasons) * Dermatology (for medical condition) * Diabetic Equipment and Supplies * Diagnostic Tests and Procedures * Diaper Rash Creams * Diapers, Diaper Service* Diarrhea Medicine
* Diathermy
* Diet Food
* Dietary Supplement (for general health) * Dietary Supplement (for medical condition)* Dietician
* Digestive Aids (for general health) * Digestive Aids (for medical condition) * Digestive Aids (over-the-counter) * Disabled Dependent Care * DNA Collection and Storage (for paternity testing)* Doctor Fees
* Doula Fees
* Drug Addiction Treatment * Drug Overdose Treatment * Drugs (controlled substances) * Drugs (over-the-counter) * Drugs (prescription) * Durable Medical Equipment (DME) * Dyslexia Treatment * Ear Care and Ear Wax Removal Products* Ear Plugs
* Ear, Body Piercing * Educational Classes (for medical condition) * Educational Classes (non-medical/general well-being) * Egg and Embryo Storage Fees * Egg and Sperm Donor Fees * Egg Recipient Fees * Electrolysis (hair removal for cosmetic reasons) * Electrolysis (hair removal for medical condition) * Electronic Cigarettes* Elevator
* Epsom Salts
* Erectile Dysfunction Treatment * Excess Skin Removal * Exercise Equipment, Exercise Program (for general health) * Exercise Equipment, Exercise Program (for medical condition)* Expectorant
* Expenses not incurred during the coverage period * Expenses that have been reimbursed previously under or could be reimbursed under another medical plan * Experimental Drugs * Experimental Medical Services * Eye Care (for eye drops) * Eye Care, Eyeglasses (warranties) * Eye Exams, Eyeglasses, Eye Surgery, Eye Care * Eye Exams, Eyeglasses, Eye Surgery, Eye Care (for repairs) * Eye Exams, Eyeglasses, Eye Surgery, Eye Care (not needed for visioncorrection)
* Face Lift (for cosmetic reasons) * Feminine Hygiene Products * Fertility Enhancement and Treatments * Fertility Enhancement and Treatments (fees for preserving) * Fertility Enhancement and Treatments (ovulation kit) * Fertility Enhancement and Treatments (surrogate or gestationalcarrier expenses)
* Fever Reducing Medication * Fiber Supplement (for general health) * Fiber Supplement (for medical condition)* Finance Charges
* First Aid Drugs and Medicines* First Aid Kit
* First Aid Supplies * Fitness Program (for general health) * Fitness Program (for medical condition) * Flavoring Added to Medication* Flu Shot
* Fluoride Device and Treatment (In home or Office) * Fluoride product (over-the-counter) * Fluoride Rinse, Pills and Toothpaste* Food
* Foot Care (non-medicated) * Foot Care (over-the-counter)* Forms Completion
* Founder’s Fees
* Fuel, Gasoline for Medical Care* Funeral Expenses
* Gambling Treatment * Gastric Bypass Surgery Including Excess Skin Removal (for cosmeticreasons)
* Gastric Bypass Surgery Including Excess Skin Removal (for medicalcondition)
* Gastric Bypass Surgery Including Excess Skin Removal (for obesitytreatment)
* Gauze Pads
* Genetic Testing
* GIFT (Gamete intrafallopian transfer) * Glucosamine and Glucosamine Chondroitin * Glucose Monitoring Device* Glucose Tabs
* Goggles (prescription)* Guide Dog
* Gynecologist
* Hair Removal or Transplant (for cosmetic reasons) * Hair Removal or Transplant (for medical condition)* Half Way House
* Handicap, Disability Placards and License Plates * HDHP, High-deductible health plan (premiums)* Headache Medicine
* Health Club or Gym Membership Fees (for general health/non-medical) * Health Club or Gym Membership Fees (for medical condition)* Health Screenings
* Hearing Aids and Batteries * Heart Rate Monitors* Heating Pads
* Hemorrhoid Treatment * Herbs and Herbal Supplement (for general health) * Herbs and Herbal Supplement (for medical condition) * HMO, Health Maintenance Organization (premiums) * Holistic, Homeopathic Professional (for general health) * Holistic, Homeopathic Professional (for medical condition) * Home Diagnostic Kits, Tests, Devices* Home Health Care
* Home Improvements
* Homeopathic Care and Medicines * Homeopathic Care and Medicines (for general health) * Hormone Replacement Therapy (HRT) (for medical condition) * Hormone Replacement Therapy (HRT) (used as an enhancement) * Hospice Care/Palliative Care* Hospital Services
* Household Help
* Human Guide
* Humidifier (for medical care)* Hydrotherapy
* Hyperbaric Oxygen Therapy* Hypnosis
* Illegal Operations, Illegal Treatments* Immunizations
* Impotence
* In Vitro Fertilization* Inclinator
* Incontinence Products * Infertility Treatments * Injection Snore Plasty * Insect Bite Cream, Ointment* Insulin
* Insurance Premiums (for Medicare supplement policies) * Insurance Premiums (if you have a health care FSA) * Insurance Premiums (if you have an HSA)* Inversion Table
* Investigational Surgery * Invisalign Orthodontics * Joint Supplement (for general health) * Joint Supplement (for medical condition) * Kenalog Injections (for cosmetic reasons) * Kenalog injections (for medical condition)* Kenesio Tape
* Kinesiology
* Laboratory Fees
* Lactation Aids and Supplies * Lactation Consultant* Laetrile
* Lamaze Classes (not related to the actual childbirth) * Lamaze Classes (related to childbirth)* Language Classes
* Lap Band Surgery (for cosmetic reasons) * Lap Band Surgery (for medical condition) * Lap Band Surgery (for obesity treatment) * LASIK, Laser Eye Surgery* Late Payment Fee
* Laxatives
* Lead Paint Correction (repaint affected area) * Lead Paint Removal (for medical condition) * Learning Disabilities * Legal Fees (for adoption) * Legal Fees (for divorce) * Legal Fees (for fertility treatment) * Legal Fees (for guardian/estate) * Legal Fees (for surrogate mother) * Legal Fees (to authorize treatment) * Lessons (for medical condition) * Lessons (non-medical) * Lice Treatment and Removal (fees paid to specialist) * Lice Treatment and Removal (over-the-counter) * Life Alert Emergency Medical Alert System* Life Coach
* Lip Balm (SPF 15 or higher) * Lip Balm (SPF lower than 15) * Liposuction (for cosmetic reasons) * Liposuction (for medical condition) * Liquid Adhesive Bandage for Small Cuts * Lodging and Trips (for general health) * Lodging and Trips (to receive medical care) * Long Term Care Insurance Premiums (if you have a health care FSA) * Long Term Care Insurance Premiums (if you have an HSA) * Long Term Care Services * Long Term Disability (LTD) Insurance Premiums (if you have a healthcare FSA)
* Long Term Disability (LTD) Insurance Premiums (if you have an HSA)* Lumbar Support
* Marijuana
* Marriage Counseling * Massage Therapy (for general health) * Massage Therapy (for medical condition) * Mastectomy-Related Expenses* Maternity Aids
* Maternity Charges
* Maternity Clothes
* Mattress
* Meals (for a companion) * Meals (for inpatient care) * Medical Alert Bracelet, Necklace * Medical Care Outside U.S. * Medical Conference (admission and transportation) * Medical Information Storage Plan * Medical Monitoring, Testing Devices * Medical Newsletter* Medical Records
* Medical Services (monthly/annual fee) * Medical Services (payment for treatment of medical condition) * Medical Services (phone consultation) * Medical Services (virtual office visits) * Medicare Parts A, B and D (if you have a health care FSA) * Medicare Parts A, B and D (if you have an HSA) * Medicated Lip Product (for cold sore/fever blister) * Medicated Lip Product (lip balm lower than SPF 15) * Medicated Lip Product (lip balm SPF 15 or higher) * Medicine and Drugs from Other Countries (purchased and consumed inanother country)
* Medicine and Drugs from Other Countries (purchased in another country for use in U.S.) * Medicine and Drugs, Over-the-Counter (OTC) * Medicine, Prescription * Medicine, Prescription (for cosmetic reasons)* Mediscope
* Menstrual Pain Reliever * Mentally Challenged, Special Home * Micro-Dermabrasion (for cosmetic reasons)* Midwife
* Migraine Relief (over-the-counter) * Mileage (primarily for medical care) * Minerals, Mineral Supplement (for general health) * Minerals, Mineral Supplement (for medical condition) * Missed Appointment Fees* Monitor
* Morning-After Contraception Pill* Motion Sickness
* Mouth Guard
* Nasal Aspirator
* Nasal Sprays, Nasal Solutions* Nasal Strips
* Natural Lens Replacement * Naturopathic Care, Naturopathic Healers (for general health) * Naturopathic Care, Naturopathic Healers (for medical condition) * Naturopathic Healers* Nebulizer
* Neti Pot
* Neurologist
* Newborn Nursing Care * Nicotine Gum and Patches * Non-Prescription Drugs, Medicines * Norplant insertion or removal * NSAIDS (over-the-counter) * Nursing Home (medical care, meals and lodging) * Nursing Pillows or Covers * Nursing services provided at home* Nursing Supplies
* Nutritional Supplement (for general health) * Nutritional Supplement (for medical condition) * Nutritionist (for general well-being) * Nutritionist (for medical condition)* Obstetrical Care
* Obstetrical Care (prepaid expenses for the birth)* Occlusal Guard
* Occupational Therapy* Oncologist
* Operation (for cosmetic reasons) * Operation (for medical care)* Ophthalmologist
* Optometrist
* Organ Donor Expenses (paid by donor) * Organ Donor/Recipient Expenses (paid by recipient) * Organ Recipient Expenses (paid by the donor)* Orthodontia
* Orthokeratology
* Orthopedic Shoes
* Orthotics
* OSHA Handling Fees for Bio-Hazards Waste Disposal.* Osteopath
* Ostomy, Colostomy Supplies * OTC (over-the-counter) * Out-of-Network Provider * Over-the-Counter (OTC) Drugs and Medicines * Over-the-Counter (OTC) Supplies* Ovulation Monitor
* Oxygen
* Pain Relievers (Over-the-counter) * Parking Fees (primarily for medical care) * Particulate Respirator Mask * Pastoral Counseling* Paternity Testing
* Patterning Exercises* Peak Flow Meter
* Pediculicide/Lice Treatment* Pedometer
* Penile Implants
* Personal Items
* Personal Trainer Fees (for general health) * Personal Trainer Fees (for medical condition)* PET Scan
* Petroleum Jelly
* Phone Consultation with Doctor* Phototherapy
* Physical exam
* Physical Exam for Caregiver* Physical Therapy
* Physician Fees, Pre-Paid * Pill Cutters, Pill Box, Pill Sorters and Pill Organizers * Pillows for Lumbar and Cervical Support * Post Mastectomy Clothing * Pre-Existing Condition * Pregnancy and Delivery Charges * Pregnancy Charges Paid Monthly per Contract* Pregnancy Items
* Pregnancy Termination* Pregnancy Tests
* Premiums (for Medicare supplement policies) * Premiums (if you have a health care FSA) * Premiums (if you have an HSA)* Prenatal Vitamins
* Pre-Paid Payments
* Prescription Drug Discount Program * Prescription Drugs, Medicines * Preventative Care Screenings * Preventive Care Services * Private Hospital Room * Probiotics (for general health) * Probiotics (for medical condition) * Progesterone, Testosterone Hormones (for cosmetic reasons) * Progesterone, Testosterone Hormones (for medical condition) * Propecia (for cosmetic reasons) * Propecia (for medical condition)* Prosthesis
* Psychiatric Services and Care* Psychoanalysis
* Psychologist
* Psychotherapist
* Psychotherapy
* Pulse Oximeter
* Purifier
* Radial Keratotomy
* Reading Glasses
* Reasonable & Customary (R&C)* Reflexology
* Rehabilitation Center (custodial care for permanent residence) * Rehabilitation Center (meals and lodging)* Respite Care
* Restylane Injections (for cosmetic reasons)* Retention Fees
* Retin-A (for effects of aging) * Retin-A (for medical condition) * Rhinoplasty (for cosmetic reasons) * Rogaine (for cosmetic reasons) * Rogaine (for medical condition) * Rolfing, Structural Integration * Safety Glasses (Prescription)* Sales Tax
* Scale, food or weight* Schools, Special
* Screening Tests
* Seeing-eye Dog, Service Animal * Services Not Covered by Insurance* Sexual Counseling
* Sexual Dysfunction * Shampoos and Soaps* Sharps Container
* Shipping and Handling* Sinus Medication
* Sitz Bath
* Skin Tag Removal (for cosmetic reasons) * Skin Tag Removal (for medical condition) * Sleep Deprivation Treatment * Smoking Cessation Program and Medication * Smoking Cessation Program and Medication (over-the-counter)* Somnoplasty
* Special Computer Program for the Blind* Special Food
* Specialized Medical Equipment or Services* Speech Therapy
* Speech Therapy (dvds, videos, software) * Sperm Storage (for medical reasons) * Sperm Storage (for non-medical reasons)* Spermicide
* Stem Cell Harvesting or Storage (for medical reasons) * Stem Cell Harvesting or Storage (for non-medical reasons) * Stem Cell Injections * Sterilization Procedure or Reversal * Stop-Smoking Program * Student Health Fee (cost of medical care) * Student Health Fee (fees/premium for program) * Substance Abuse Treatment * Subway Fare (primarily for medical care) * Sunburn Cream, Ointment * Sunglasses (no vision correction) * Sunglasses (with prescription) * Sunscreen (lower than SPF 15) * Sunscreen (SPF 15 or higher) * Supplement (for general health) * Supplement (for medical condition)* Support Hose
* Suppositories
* Surgery (for cosmetic reasons) * Surgery (for medical care) * Surrogate Mother Fees (for medical expenses for the surrogate) * Surrogate Mother Fees (for medical expenses, if member issurrogate)
* Surrogate Mother Fees (for search of surrogate) * Swimming Lessons (for medical condition) * Swimming Lessons (non-medical) * Swimming Pool (for medical condition) * Swimming Pool (for recreation) * Syntonic Phototherapy * Tanning Salon Visits or Equipment (for cosmetic reasons/appearance) * Tanning Salon Visits or Equipment (for medical condition) * Tattoo Removal (for cosmetic reasons) * Taxes on Medical Services and Products * Taxi Fare (primarily for medical care) * Teething, Toothache Remedies * Telephone Consultation Fee * Telephone for Hearing Impaired (cost of phone in hospital/treatmentcenter)
* Telephone for Hearing Impaired (fees for enhancing/repairing aphone)
* Television for Visually or Hearing Impaired (cost of TV in hospital/treatment center) * Television for Visually or Hearing Impaired (cost to modify TV orbuy new)
* Temporary Continuation of Coverage (TCC) Premiums (if you have ahealth care FSA)
* Temporary Continuation of Coverage (TCC) Premiums (if you have anHSA)
* Therapy (for medical condition) * Therapy (marriage/family for non-medical reasons) * Thermacare Heat Wraps* Thermography
* Thermometer
* Throat Lozenges
* Toiletries (Personal Hygiene) * Toll Fees (primarily for medical care)* Toothbrushes
* Topical Analgesics (Muscles and Arthritis)* Topical Steroids
* Train Fare (primarily for medical care)* Transplant
* Transportation (for medical care) * Transportation (for nurse or companion) * Transportation (non-medical) * Transportation (to attend Alcoholics Anonymous) * Transportation Cost of Disabled Individual Commuting To and FromWork
* Tri-Care Premiums (if you have a health care FSA) * Tri-Care Premiums (if you have an HSA) * Trips (for general health) * Trips (to receive medical care) * Tubal Ligation, Tubal Ligation Reversal * Tuition (for special school/program)* Tummy Tuck
* Tutoring
* Ultrasound
* Ultrasound, Pre-Natal (non-medical request by patient) * Ultrasound, Pre-Natal (to monitor growth/condition) * Umbilical Cord Blood (harvesting/storage for medical condition) * Umbilical Cord Blood (harvesting/storage for non-medical reasons)* Urinalysis
* Usual, Customary and Reasonable (UCR), Charges Above* UVR treatments
* Vaccinations
* Vaporizer, Humidifier * Varicose Veins Treatment (for cosmetic reasons) * Varicose Veins Treatment (for medical condition) * Vasectomy, Vasectomy Reversal * Veneers (for cosmetic reasons) * Veneers (non-cosmetic) * Veterinary Fees (for guide dog/animal)* Vision Correction
* Vision Discount Programs * Vitamin (for general health) * Vitamin (for medical condition)* Walker
* Warranty
* Wart Removal Treatment* Waterpik
* Weight Loss Drugs, Medicines (over-the-counter for medicalcondition)
* Weight Loss Drugs, Medicines (prescribed) * Weight Loss Programs (for general health) * Weight Loss Programs (for medical condition) * Well Baby, Well Child Care* Wellness Scan
* Wheelchair, Walker* Whirlpool Baths
* Wig (for medical condition) * Wig (styling or cleaning products) * Work Related Physical Examination for the Employee* X-Ray
* Yeast Infection Medication SHOWING RESULTS FOR "" Abdominoplasty (for cosmetic reasons) Generally, the cost of an abdominoplasty is not an eligible medical expense. This procedure may also be known as a Tummy Tuck. The cost of cosmetic surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: adominoplasty, breast augmentations, enhancement, electrolysis (hair/removal), face lift, hair transplant, liposuction, tattoo removal, collagen injections. Ineligible Abdominoplasty (for medical condition) A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Acne (over-the-counter item) The cost of an OTC acne medicine is an eligible medical expense. OTC products include, but are not limited to: Acne Free, Acnomel, Bye Bye Blemish, Clean & Clear, Clearasil, Murad Acne Complex Kit, Neutrogena Acne Treatment, OXY, Pro-active Solution, Stri-Dex, SAPZYT AcneTreatment. Eligible
Acne (routine skin care) Cost of routine skin care is not an eligible medical expense.Ineligible
Acne (services)
If the primary purpose is treatment of acne, acne services are eligible medical expenses. EligibleAcupressure
A health care professional must provide evidence of medical necessity for the cost of acupressure to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursesment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical conditiont. RequiredAcupuncture
The cost of acupuncture is an eligible medical expense. EligibleAdaptive Equipment
The cost to purchase or rent adaptive/durable medical equipment is an eligible medical expense. This includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet. Eligible Adoption Medical Expenses (for tax qualified dependents) If the child is a tax-qualified dependent at the time of service, medical expenses paid for a child prior to adoption are eligible medical expenses. Eligible Adoption Medical Expenses (incurred before adoption negotiations) Fees relating to the adoption process and fees for medical expenses incurred prior to beginning adoption negotiations are not eligible medical expenses. Ineligible Adoption Medical Expenses (incurred by birth mother, associated withbirth)
Expenses incurred by the birth mother associated with an adopted baby’s birth are not eligible medical expenses. Ineligible Air Conditioner, Air Filter, Air Purifier A health care professional must provide evidence of medical necessity for the cost of a portable or permanent unit to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the Air Conditioner, Air Filter, Air Purifier is a permanent improvement that increases the value of the property, the excess value is not reimbursable. Also see Publication 502 at www.irs.gov for more information, including a worksheet. Required Air Fare (primarily for medical care) The cost of air fare primarily for and essential to medical care, is an eligible medical expense. Air fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons. Eligible Alcoholism, Drug Addiction Treatment The cost of treatment at a center for alcohol or drug addiction is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment. EligibleAllergy Medicine
The cost of an OTC allergy medicine is an eligible medical expense. OTC products include, but are not limited to: Benadryl, Claritin, Dimetapp, Zyrtec. Eligible Allergy Products (used even without allergies) If the product would be owned even without allergies (such as a pillow or vacuum cleaner), the expense is generally not an eligible expense.Ineligible
Allergy Treatment Products (required for medical condition) A health care professional must provide evidence of medical necessity for the cost of allergy treatment products to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical conditiont. Note: The reimbursable expense includes only the amount above the cost of the product in its standardform. Required
Alopecia Treatment
Alopecia is a medical condition resulting in the loss of hair from the body or head that can lead to baldness. A health care professional must provide evidence of medical necessity for the cost of alopecia treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement that specifically identifies that the recommendation and expense is for treatment of the medical condition. RequiredAlternative Healers
Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition.Eligible
Alternative Medicine, Alternative Healers (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Ineligible Alternative Medicine, Alternative Healers (for medical condition) Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include evidence of medical necessity (i.e., a doctor's note or LOMN that specifically identifies that the recommendation and expense is for treatment of the medical condition) with the request for reimbursement. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition.Required
Ambulance Service
The fee paid for ambulance service is an eligible medical expense.Eligible
Analgesics (painkillers), Antipyretics (fever reducers) The cost of an OTC analgesic is an eligible medical expense. OTC products include, but are not limited to: Advil, Aspirin, Midol, Naprosyn, Pamprin, Premsyn PMS, Tylenol, Aspercreme, BenGay, Icy Hot.Eligible
Anesthesiology
Anesthesiology fees are eligible medical expenses Eligible Antacids, Acid Reducers The cost of an OTC antacid is an eligible medical expense. OTC products include, but are not limited to: Alka-Seltzer, Brioschi, Maalox, Milk of Magnesia, Mylanta, Pepto-Bismol, Prilosec. Eligible Antibiotics, topical The cost of an OTC antibiotic is an eligible medical expense. OTC products include, but are not limited to: Cortaid, Neosporin, Polysporin. EligibleAnti-Diarrhea
The cost of an OTC anti-diarrhea product is an eligible medical expense. OTC products include, but are not limited to: Pepto Bismol, Imodium AD, Kaopectate. Eligible Anti-Embolism Socks, Stockings The cost of compression socks, also known as anti-embolism socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense. EligibleAnti-Fungal
The cost of an OTC anti-fungal product is an eligible medical expense. OTC products include, but are not limited to: Lamisil AT, Lotrimin AF,Micatin. Eligible
Anti-Gas
The cost of an OTC anti-gas product is an eligible medical expense. OTC products include, but are not limited to: Mylanta, Gelusil, Phazyme, Gas-X. EligibleAntihistamines
The cost of an OTC antihistamine is an eligible medical expense. OTC products include, but are not limited to: Benadryl, Claritin, Contac, Dimetapp, Sudafed, Triaminic. EligibleAnti-Itch
The cost of an OTC anti-itch product is an eligible medical expense. OTC products include, but are not limited to: Aveeno/Gold Bond Anti-Itch, Benadryl, Cortaid, Calamine lotion, Cortizone, Lanacane.Eligible
Appearance Improvement Appearance improvement for cosmetic reasons is not an eligible medical expense. The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense because it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Arch and Insole Support The cost of custom made and over the counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense. EligibleArthritis Care
The cost of an OTC arthritis medicine is an eligible medical expense. OTC products include, but are not limited to: Arthritis gloves, Arthritis Hot, Bengay, Capzasin. Eligible Artificial Eye, Limb, Teeth Amount paid for the design and purchase of an artificial limb, eye or teeth is an eligible medical expense. Eligible Artificial Insemination (active attempt to conceive) When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Artificial Reproductive Technologies (active attempt to conceive) When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Aspirin
The cost of an OTC aspirin is an eligible medical expense. Eligible Assisted Living Facility Living expenses in an assisted living facility for permanent residence are not eligible medical expenses. Ineligible Asthma Equipment and Treatment The cost of asthma equipment (e.g., a nebulizer or peak flow meter) is an eligible medical expense. Eligible Asthma Equipment and Treatment (over-the-counter products) The cost of an OTC asthma product is an eligible medical expense. OTC products include, but are not limited to: Bronkaid, Bronkolixir,Primatine. Eligible
Autoette (wheelchair) The cost of an autoette is an eligible medical expense. Eligible Automated External Defibrillator (AED) The cost of an automated external defibrillator is an eligible medicalexpense. Eligible
Automobile Modifications (cost of operating the car) The cost of operating a specially equipped car is not an eligible medical expense. Ineligible Automobile Modifications (for medical condition) A health care professional must provide evidence of medical necessity for the cost of car modifications such as hand controls and other special equipment installed in a car including installation costs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car. Required Automobile Modifications (specially designed car to hold a wheelchair) The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car. EligibleAutopsy
Fees associated with an autopsy are not eligible medical expenses.Ineligible
Baby Formula
For the cost of baby formula to be an eligible medical expense, a health care professional must provide evidence of medical necessity showing that the qualified employee’s infant requires special dietary requirements, and a specific baby formula is recommended to treat the illness or disorder. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is calculated using a cost difference method of subtracting the amount paid for standard baby formula from the cost of the special formula. Required Babysitting, Child and Dependent Care (for healthy child) The cost of babysitting, child care and nursing services for a healthy child or dependent are not eligible medical expenses. IneligibleBack Brace
Both Rigid (Hard) and Soft (Elastic) Back Braces are eligible medicalexpenses. Eligible
Baldness Treatment (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Baldness Treatment (for medical condition) A health care professional must provide evidence of medical necessity such as the result of chemotherapy treatment, disease, trauma or injury for the cost of treatment, for baldness to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredBandages, Band-Aids
The cost of bandages is an eligible medical expense. Bandages include, but are not limited to: Ace bandages, Band-Aid, Curad, Johnson & Johnson, Nexcare. EligibleBariatric Surgery
A health care professional must provide evidence of medical necessity for the cost of bariatric surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Bariatric Surgery (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Bariatric Surgery (for obesity treatment) The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of thesesurgeries. Eligible
Bedside Commode, Toilet (for medical reasons) The cost to purchase or rent a bedside commode or bedside toilet is an eligible medical expense. Eligible Behavioral Modification Programs A health care professional must provide evidence of medical necessity for the cost of special and residential schools/programs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments for a special program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school/program may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birthdefect. Required
Bio-identical Hormone Replacement Therapy (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Bio-identical Hormone Replacement Therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Bio-identical Hormone Replacement Therapy (used as an enhancement) Hormone replacements used as an enhancement for body-builders, athletes and others are not eligible medical expenses. Ineligible Birth Control (over-the-counter) The cost of an OTC birth control product is an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. Eligible Birth Control (prescription) The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. Eligible Birthing Classes (not related to the actual childbirth) The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breastfeeding vs. bottle feeding, newborn care) is not an eligible medical expense. Ineligible Birthing Classes (related to childbirth) Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for thatportion. Eligible
Birthing Coach
A health care professional must provide evidence of medical necessity for the cost of a birthing coach who provides medical care for the mother or child to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Bleaching or Whitening Teeth The cost of bleaching or whitening teeth is not an eligible medicalexpense. Ineligible
Blepharoplasty (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Blepharoplasty (for medical condition) A health care professional must provide evidence of medical necessity for Blepharoplasty to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredBlood Donor Fee
A health care professional must provide evidence of medical necessity for the cost of blood donation to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: A fee associated with blood donation is an eligible medical expense when the blood is for use by the participant, spouse or eligible dependent. Required Blood Pressure Monitor The cost of a blood pressure monitoring device is an eligible medicalexpense. Eligible
Blood Storage
A health care professional must provide evidence of medical necessity for the cost of blood storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to store blood would be an eligible medical expense. Required Blood Sugar Test Kits and Strips Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs. Eligible Body Restoration Technique A health care professional must provide evidence of medical necessity for the cost of body restoration to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredBody Scan
The cost of a body scan (e.g., an MRI, PET, CAT) is an eligible medical expense. Eligible Botox Injections (for cosmetic reasons) Amounts paid for cosmetic services, such as Botox injections to eliminate wrinkles, are not eligible medical expenses. Ineligible Botox Injections (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Botox injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note of LOMN must specifically identify the recommendation and expense is for treatment of the medical condition (i.e. treatment of migraines). Required Boutique, Concierge, Practice Fees The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care isneeded. Ineligible
Bracanalysis Testing The cost of diagnostic testing for genetic mutations that may include DNA collection is an eligible medical expense. EligibleBraces, Orthodontia
The cost of orthodontia care (including braces and invisalign) is an eligible medical expense. Eligible Braille Books and Magazines For use by visually impaired persons, the cost of Braille books and magazines are eligible medical expense. Note: The eligible expense includes only the amount above the cost of the product in its standardform. Eligible
Breast Augmentation (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Breast Implants or Removal (for cosmetic reasons) The cost to replace a cosmetic implant (i.e. reduction or enlargement) is not an eligible medical expense. Ineligible Breast Implants or Removal (for medical condition) A health care professional must provide evidence of medical necessity for the cost of breast implants or removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Breast Pump Purchase or Rental The cost to purchase or rent a breast pump is an eligible medicalexpense. Eligible
Breast Reconstruction Surgery The cost of breast reconstruction surgery following a mastectomy is an eligible medical expense. Eligible Breast Reduction (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Breast Reduction (for medical condition) A health care professional must provide evidence of medical necessity for the cost of breast reduction surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Breastfeeding Supplies Breastfeeding supplies are the equipment and disposable supplies that assist with breastfeeding or nursing. The cost of those supplies are eligible medical expenses. This includes but is not limited to: breast pumps, disposable bra pads, lanolin cream, breastfeeding tubes and containers. EligibleBreathalyzer
The cost of both in-home and doctor's office alcohol testing are eligible expenses. Eligible Bus Fare (primarily for medical care) The cost of bus fare primarily for and essential to medical care, is an eligible medical expense. Bus fare expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons.Eligible
Calcium (for general health) When calcium is taken for general good health (even when recommended by a health care professional), the amounts paid for calcium are not eligible medical expenses. Ineligible Calcium (for medical condition) A health care professional must provide evidence of medical necessity for the cost of calcium to be an eligible medical expense. Include a doctor's note or Letter of Medical (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Capital Expense (cost of installing equipment in home) A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as a ramp or wheelchair lift) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov . Required Car Modification (cost of operating the car) The cost of operating a specially equipped car is not an eligible medical expense. Ineligible Car Modification (for medical condition) A health care professional must provide evidence of medical necessity for the cost of car modifications such as hand controls and other special equipment installed in a car including installation costs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Car Modification (specially designed car to hold a wheelchair) The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car. Eligible Car Rental (primarily for medical care) The cost of a car rental primarily for and essential to medical care, is an eligible medical expense. Car rental expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons.Eligible
Carpal Tunnel Wrist Supports, Braces The cost of carpal tunnel wrist supports is an eligible medicalexpense Eligible
Cervical Pillow
A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredChairs, Reclining
A health care professional must provide evidence of medical necessity for the cost of a reclining chair to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is calculated using a cost difference method of subtracting the amount paid for a standard chair from the cost of a specialized chair. RequiredChelation Therapy
A health care professional must provide evidence of medical necessity such as lead poisoning for the cost of chelation therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Chemical Peel (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. IneligibleChildbirth
Amounts paid to a physician or licensed midwife for child delivery are eligible medical expenses. Eligible Childbirth Classes/Lamaze (not related to the actual childbirth) The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breastfeeding vs. bottle feeding, newborn care) is not an eligible medical expense. Ineligible Childbirth Classes/Lamaze (related to childbirth) Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for thatportion. Eligible
Chinese Herbal Practioner and Herbal Treatments (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Ineligible Chinese Herbal Practitioner Treatments provided by a Chinese Herbal Practitioner are eligible if treating a specific medical condition. EligibleChiropody
Amounts paid to a chiropodist (a chiropractic foot doctor) is an eligible medical expense. EligibleChiropractor
The cost of chiropractor services is an eligible medical expense.Eligible
Cholesterol Testing
OTC portable blood test systems (such as Cardio Chek) and test strips are an eligible medical expense. Eligible Christian Science Practitioners Treatments provided by a Christian Science Practitioners are eligible if treating a specific medical condition. Eligible Christian Science Treatments (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. IneligibleCircumcision
The cost of circumcision is an eligible medical expense. EligibleClinic
The cost of medical treatment at a health clinic is an eligible medical expense. Eligible Club Dues and Fees (for general health/non-medical) Health club dues paid for general health or to relieve physical or mental discomfort not related to a medical condition are not eligible medical expenses. Ineligible Club Dues and Fees (for medical condition) A health care professional must provide evidence of medical necessity for the cost of dues paid to a health club or gym to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is only for the individual membership and for the component that is related to the current plan year. Any dues that carry over to another plan year must be submitted for that plan year of coverage. Even if you're required to prepay for an entire year, membership fees may only be reimbursed each month. Required COBRA Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible COBRA Premiums (If you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. However, insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap.Eligible
Co-Insurance
A coinsurance charge for medical care is an eligible medicalexpense. Eligible
Cold and Hot Packs (for medical purposes) When used for medical purposes, amounts paid for cold and hot packs are eligible medical expenses. Eligible Cold and Hot Packs (for non-medical use) When used for other purposes (e.g., to keep beverages hot or cold), amounts paid for cold and hot packs are not eligible medical expenses.Ineligible
Cold Medicines
The cost of an OTC cold medicine is an eligible medical expense. OTC products include, but are not limited to: Advil, Comtrex, Contac, Coricidin, Dayquil, Mucinex, Nyquil, Robitussin, Sudafed, TheraFlu, Triaminic, Vicks. Eligible Cold Sore and Fever Blister Treatments (lip balm SPF 15 or higher) The cost of medicated lip balm with an SPF 15 or higher is an eligible medical expense. Eligible Cold Sore and Fever Blister Treatments (lip balm SPF lower than 15) The cost of medicated lip balm with no SPF or an SPF lower than 15 is not an eligible medical expense. Ineligible Cold Sore and Fever Blister Treatments (over-the-counter) The cost of an OTC cold sore or fever blister product is an eligible medical expense. OTC products include, but are not limited to: Abreva Cream, Herpecin. Eligible Collagen Injections (for cosmetic reasons) The cost of collagen injections for cosmetic purposes is not an eligible medical expense. Ineligible Collagen Injections (for medical condition) A health care professional must provide evidence of medical necessity such as urinary incontinence or severe acne for the cost of collagen injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Colon Therapy, Colon Hydrotherapy, Colonics A health care professional must provide evidence of medical necessity for the cost of colon therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredCompanion Animal
The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses. Eligible Compression Socks, Stockings The cost of compression socks, also known as anti-embolism socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense. EligibleConcierge Medicine
The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care isneeded. Ineligible
Condoms
The cost of condoms are an eligible medical expense. Eligible Contact Lens Service Agreement and Warranty Any fees for vision discount programs or warranties are not eligible medical expenses. Ineligible Contact Lenses and Supplies (for cosmetic reasons) Amounts paid for cosmetic contact lenses (such as to change eye color without vision correction) are not eligible medical expenses.Ineligible
Contact Lenses and Supplies (for vision correction) If contact lenses are needed to correct vision, amounts paid for the purchase of contact lenses (including shipping and handling fees) are eligible medical expenses. Amounts paid for contact lens solution, cleaning or soaking solutions, lens storage cases, supplies and exams (including fittings) are also eligible expenses. Eligible Contact Lenses and Supplies (over-the-counter products) The cost of an OTC eye drop and re-wetting product is an eligible medical expense. OTC products include, but are not limited to: Visine, Opcon-A, Clear eyes. Eligible Continuous Positive Airway Pressure (CPAP) The cost of the breathing therapy known as CPAP is an eligible medicalexpense. Eligible
Contraceptives
The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. Eligible Controlled Substances The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible. Ineligible Convalescent Home (custodial care) The cost of custodial care in a convalescent or nursing home (e.g., long term care) is not an eligible medical expense. Ineligible Convalescent Home (medical care, meals & lodging) A health care professional must provide evidence of medical necessity for the cost of medical care provided during a temporary stay in a convalescent, nursing home or skilled facility, (e.g., following a hospital stay or surgery) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the convalescent/nursing home if the main reason for being there is to receive medical care in order to return home. If participant resides permanently in the facility, only separately stated medical expenses would be eligible for reimbursement (e.g. individually billed doctor visits; prescription costs). RequiredCopayment (copay)
A medical copayment is an eligible medical expense. Note: The receipt must clearly state that the expense is a copayment for a healthcareservice. Eligible
Cord Blood (harvesting/storage for medical condition) A health care professional must provide evidence of medical necessity with the infant or other family member covered under the health care account, for the cost of harvesting and storing cord blood to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect, freeze and store umbilical cord blood would be an eligible medical expense. Required Cord Blood (harvesting/storage for non-medical reasons) Storage and harvesting fees paid for non-medical reasons or to preserve the cord blood for future use are not eligible medical expenses. IneligibleCorneal Molding
Cost for orthokeratology (also known as corneal molding) is an eligible medical expense. It is a surgical procedure similar to Lasik Surgery to improve or correct near sightedness, far sightedness and astigmatism. Eligible Corneal Ring Segments The cost of these devices implanted in the eye to correct vision is an eligible medical expense. Eligible Cosmetic Treatment (for medical condition) A health care professional must provide evidence of medical necessity such as improve a deformity arising from, or directly related to, a congenital abnormality, personal injury or disfiguring disease, for the cost of cosmetic surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Cosmetic Treatment (for non-medical reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. IneligibleCough Suppressants
The cost of an OTC cough suppressant is an eligible medical expense. OTC products include, but are not limited to: cough syrup and coughdrops. Eligible
Counseling (for medical condition) The cost of counseling for a medical condition is an eligible medicalexpense. Eligible
Counseling (marriage/family for non-medical reasons) Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses. IneligibleCPR
The cost of a CPR class is not an eligible medical expense. Ineligible Crania-Sacral Therapy A health care professional must provide evidence of medical necessity for the cost crania-sacral therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredCrown, dental
The cost of a crown is an eligible medical expense. EligibleCrutches
The purchase or rental of crutches is an eligible medical expense.Eligible
Crystalens
Artificial lens implants used to treat cataracts is an eligible medical expense. The cost of the FDA approved procedure where the patient’s lens is removed and replaced with a clear plastic lens that allows him or her to focus more accurately is also an eligible medical expense. Eligible Dance Lessons (for medical condition) A health care professional must provide evidence of medical necessity for the cost of fees paid for lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Dance Lessons (non-medical) Fees paid for lessons not recommended by a health care professional or not specific to a medical condition are not eligible medical expensesIneligible
Decongestant
The cost of an OTC decongestant is an eligible medical expense. OTC products include, but are not limited to: Contac-D, Dimetapp, Sudafed,Triaminic. Eligible
Deductibles
Deductibles are eligible medical expenses. EligibleDefibrillator
The cost of a defibrillator is an eligible medical expense. EligibleDehumidifier
The cost of a dehumidifier is not an eligible medical expense.Ineligible
Dehydration Treatment The cost of an OTC dehydration product is an eligible medical expense. OTC products include, but are not limited to: Pedialyte. Eligible Dental Emergency Kit A dental emergency kit used for the temporary repair of loose caps or lost fillings is an eligible medical expense. Eligible Dental Maintenance Organization (DMO) Fees (if you have a health careFSA)
Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Dental Maintenance Organization (DMO) Fees (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Eligible Dental Treatment (non-cosmetic) Amounts paid for dental treatment (X-rays, fillings, extractions, dentures (artificial teeth), caps, crowns, fluoride treatments, implants, non-cosmetic veneers etc.) and orthodontia (including braces and Invisalign) are eligible medical expenses. Eligible Dental Treatment (oral hygiene & supplies) Ineligible items include, but are not limited to: toothpaste, toothbrushes (including a specialized or battery-powered toothbrush), oral hygiene products such as oral rinses, veneers for cosmetic purposes and cost of cosmetic dental treatments. Ineligible Dental Treatment (over-the-counter flouride) The cost of an OTC fluoride product is an eligible medical expense.Eligible
Dental Treatment (tooth bonding) A health care professional must provide evidence of medical necessity for tooth bonding to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredDental, cosmetic
The cost of cosmetic dental treatment is not an eligible medicalexpense. Ineligible
Denture Adhesive
The cost for a product to secure dentures in the mouth is an eligible medical expense. Examples include, but are not limited to: Fixodent, Polident, Effergrip and Sea-Bond. EligibleDenture Cleanser
The cost for a product to clean dentures is an eligible medicalexpense. Eligible
Dentures (for cosmetic reasons) Cosmetic dentures are not an eligible medical expense. Ineligible Dentures (non-cosmetic) Non-cosmetic dentures are an eligible medical expense. EligibleDenturist
Amounts paid to a denturist for the treatment of a dental condition are eligible medical expenses. (A denturist is a dental technician specializing in making and fitting dentures as a direct service to the public rather than through a licensed dentist.) Eligible Dependent Care (for disabled person) A health care professional must provide evidence of medical necessity for the cost of care for a disabled dependent to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Dependent Care (for healthy child) The cost of babysitting, child care and nursing services for a healthy child or dependent are not eligible medical expenses. Ineligible Dermabrasion (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Dermatology (for cosmetic reasons) Amounts paid to a dermatologist for cosmetic services (such as botox injections to eliminate wrinkles) are not eligible medical expenses.Ineligible
Dermatology (for medical condition) Amounts paid to a dermatologist for a medical condition (such as acne or psoriasis) are eligible medical expenses. Eligible Diabetic Equipment and Supplies Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs. Eligible Diagnostic Tests and Procedures Amounts paid for diagnostic services are eligible medical expenses.Eligible
Diaper Rash Creams
The cost of an OTC diaper rash product is an eligible medical expense. OTC products include, but are not limited to: Aquaphor, Balmex,Desitin. Eligible
Diapers, Diaper Service A health care professional must provide evidence of medical necessity for the cost of diapers and diaper service to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. However, the cost of an incontinence product is an eligible medical expense. Examples include, but are not limited to: Depend, Invacare, Poise, Prevail, Serenity.Required
Diarrhea Medicine
The cost of an OTC anti-diarrhea product is an eligible medical expense. OTC products include, but are not limited to: Pepto Bismol, Imodium AD, Kaopectate. EligibleDiathermy
The cost of diathermy used to destroy abnormal cells or as a form of physical therapy is an eligible medical expense. EligibleDiet Food
The cost of food, including diet food or meal replacements such as shakes for weight loss programs, is not an eligible medical expense to the extent it is for ordinary nutritional value. Therefore the cost of food associated with weight-loss programs, such as pre-packed meals and diet food, is not eligible since the food is a substitute for regular food and meets normal nutritional needs. Ineligible Dietary Supplement (for general health) When dietary supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for supplements, herbs, minerals, and vitamins are not eligible medical expenses. Ineligible Dietary Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredDietician
A health care professional must provide evidence of medical necessity for the cost of dietician to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Digestive Aids (for general health) When digestive aids are taken for general good health (even when recommended by a health care professional), the amounts paid for digestive aids are not eligible medical expenses. Ineligible Digestive Aids (for medical condition) A health care professional must provide evidence of medical necessity for the cost of digestive aids to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Digestive Aids (over-the-counter) The cost of over-the-counter digestive aids is an eligible medical expense. This includes but is not limited to: acid controllers, laxatives, anti-diarrheals, and anti-gas medicine. Eligible Disabled Dependent Care A health care professional must provide evidence of medical necessity for the cost of care for a disabled dependent to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required DNA Collection and Storage (for paternity testing) The cost of a DNA test to determine paternity is not an eligible medical expense IneligibleDoctor Fees
The cost of doctor fees are an eligible medical expense. EligibleDoula Fees
A health care professional must provide evidence of medical necessity for the cost of a doula who provides medical care for the mother or child to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Drug Addiction Treatment The cost of treatment at a center for alcohol or drug addiction is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment. Eligible Drug Overdose Treatment The cost of treatment for a drug overdose is an eligible medicalexpense. Eligible
Drugs (controlled substances) The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible. Ineligible Drugs (over-the-counter) The cost of an OTC product, drug or medicine is an eligible medicalexpense. Eligible
Drugs (prescription) The cost of a prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees. Eligible Durable Medical Equipment (DME) The cost to purchase or rent durable medical equipment is an eligible medical expense. DME includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet. EligibleDyslexia Treatment
A health care professional must provide evidence of medical necessity for dyslexia treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Ear Care and Ear Wax Removal Products The cost of an OTC ear care product is an eligible medical expense. OTC products include, but are not limited to: Debrox, Murine. EligibleEar Plugs
The cost of ear plugs is an eligible expense. EligibleEar, Body Piercing
The cost of ear or body piercing is not an eligible medical expense.Ineligible
Educational Classes (for medical condition) The cost of an educational class specific to a medical condition such as learning to manage diabetes or learning Braille is a qualified medical expense. Submit evidence of the medical condition as well as the class description with the request for reimbursement. Required Educational Classes (non-medical/general well-being) The cost of an educational class not specific to a medical condition or for general well-being (such as care for newborn) is not an eligible medical expense. Ineligible Egg and Embryo Storage Fees A health care professional must provide evidence of medical necessity for the cost of eggs and embryo storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to store eggs and embryos would be an eligible expense. Required Egg and Sperm Donor Fees When associated with an active attempt to conceive, amounts paid for egg and sperm donation are eligible medical expenses. A health care professional must provide evidence of medical necessity for the cost of egg and sperm donor fees to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The donor fee, agency fee, donor's medical and psychological testing, as well as legal contract fees are eligible if medically necessary for the procedure to be performed on you, your spouse or eligible dependent. RequiredEgg Recipient Fees
A health care professional must provide evidence of medical necessity for the egg recipient fees (legal, recipient testing and agency fees) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify how a patient's reproductive problems related to their medical condition results in the need for receiving eggs. Note: The egg recipient fees are eligible if medically necessary for the procedure to be performed on you, your spouse or eligible dependent. Required Electrolysis (hair removal for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Electrolysis (hair removal for medical condition) A health care professional must provide evidence of medical necessity for the cost of hair removal or a hair transplant to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Electronic Cigarettes The cost of an electronic cigarette is not an eligible medical expense. It is not an approved smoking cessation product but rather a replacement. IneligibleElevator
A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as an elevator) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov. Required
Epsom Salts
Eligible when used as a Soaking Aid for sprains and bruises. Eligible Erectile Dysfunction Treatment The cost for the treatment of erectile dysfunction is an eligible medical expense. This includes but not limited to prescribed medications: Viagra, Cialis, Levitra. EligibleExcess Skin Removal
A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Exercise Equipment, Exercise Program (for general health) The cost of exercise equipment or an exercise program for improvement of general health is not an eligible medical expense Ineligible Exercise Equipment, Exercise Program (for medical condition) A health care professional must provide evidence of medical necessity for the cost of exercise equipment/wearable technology, including a Fitbit, or an exercise program, including Wii games to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the type/name of the equipment or program is for treatment of the medical condition. If you can provide an itemized receipt separating the cost of the additional feature(s), only the amount of those additional features would be eligible for reimbursement. If you cannot provide an itemized statement showing the cost of the additional feature(s), the full cost of the product is not eligible for reimbursement. Products include but not limited to: Tom Tom, iWatch, Moto 360, Smart Watches, Android, LG, Tag Heuer. Note: The cost of a computer or Wii console would not eligible for reimbursement as they are dual purpose. RequiredExpectorant
The cost of an OTC expectorant is an eligible medical expense. OTC products include, but are not limited to: Broncolin, Mucinex, TheraFlu, Tussin EX. Eligible Expenses not incurred during the coverage period Expenses not incurred during the coverage period or before the HSA account is opened are not eligible medical expenses. Ineligible Expenses that have been reimbursed previously under or could be reimbursed under another medical plan Expenses that have been reimbursed previously under or could be reimbursed under another medical plan are not eligible medical expenses. IneligibleExperimental Drugs
The cost of prescription and legally-obtained experimental drugs for medical care is an eligible medical expense Eligible Experimental Medical Services When administered by a health care professional to treat a medical condition, the cost of experimental medical services are an eligible medical expense. Eligible Eye Care (for eye drops) The cost of an OTC eye drop is an eligible medical expense. OTC products include, but are not limited to: Visine, Wetting drops.Eligible
Eye Care, Eyeglasses (warranties) The cost of warranties for eyeglass repairs and replacements is not an eligible medical expense. Ineligible Eye Exams, Eyeglasses, Eye Surgery, Eye Care The cost of prescription eyeglasses, prescription sunglasses, eye exams, eye patches, reading glasses, OTC reading glasses, tinting of prescription eyewear, prescription goggles and prescription safety glasses are eligible medical expenses. This also includes but not limited to: cataract surgery, Lasik surgery, Corneal Rings. Eligible Eye Exams, Eyeglasses, Eye Surgery, Eye Care (for repairs) Repairs associated with the repair of Eyeglasses, Prescription Sunglasses, Reading Glasses and Prescription Goggles/Safety Glasses are eligible medical expenses. Eligible Eye Exams, Eyeglasses, Eye Surgery, Eye Care (not needed for visioncorrection)
Amounts paid for over-the-counter sunglasses, as well as eyeglasses not needed for vision correction or reading, are not eligible medical expenses. Ineligible Face Lift (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Feminine Hygiene Products The cost of feminine hygiene products are eligible medical expenses. This includes, but is not limited to: sanitary napkins, pads, liners, tampons, cups, sponges. Eligible Fertility Enhancement and Treatments When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as you, your spouse or a eligible dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Fertility Enhancement and Treatments (fees for preserving) Fees paid for preserving semen or embryos for future generations (including for genetic information) are not eligible medical expenses.Ineligible
Fertility Enhancement and Treatments (ovulation kit) The cost of an ovulation kit is an eligible medical expense. Eligible Fertility Enhancement and Treatments (surrogate or gestational carrierexpenses)
Surrogate or gestational carrier expenses are generally not eligible expenses for the participant. Ineligible Fever Reducing Medication The cost of an OTC fever reducing medicine is an eligible medical expense. OTC products include, but are not limited to: Aspirin, FeverAll, Ibuprofen, Motrin, Tylenol. Eligible Fiber Supplement (for general health) When fiber supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for fiber supplements are not eligible medical expenses. Ineligible Fiber Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredFinance Charges
Fees that are finance charges for unpaid medical expenses are not eligible medical expenses. Ineligible First Aid Drugs and Medicines The cost of an OTC first aid medicines is an eligible medical expense. OTC products include, but are not limited to: Anti-Bacterial Sprays, Antiseptics, Peroxide, Rubbing Alcohol, Witch Hazel. EligibleFirst Aid Kit
The cost of a first aid kit is an eligible medical expense. EligibleFirst Aid Supplies
The cost of first aid supplies is an eligible medical expense. First aid supplies include, but are not limited to: bandages, wraps, adhesives, cold or hot packs, gauze, joint supporters, splints, tape, thermometer. Eligible Fitness Program (for general health) The cost of a fitness program for improvement of general health is not an eligible medical expense. Ineligible Fitness Program (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a fitness program to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the program is for treatment of the medicalcondition. Required
Flavoring Added to Medication The cost of adding flavoring to medication is an eligible medicalexpense. Eligible
Flu Shot
The cost of a flu shot is an eligible medical expense. Eligible Fluoride Device and Treatment (In home or Office) A health care professional must provide evidence of medical necessity for the cost of home water fluoride treatment, including installation and rental charges to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Fluoride product (over-the-counter) The cost of an OTC fluoride product is an eligible medical expense.Eligible
Fluoride Rinse, Pills and Toothpaste Fluoride rinse, pills and toothpaste are not eligible medical expenses. IneligibleFood
The cost of food, including diet food or meal replacements such as shakes for weight loss programs, is not an eligible medical expense to the extent it is for ordinary nutritional value. Therefore the cost of food associated with weight-loss programs, such as pre-packed meals and diet food, is not eligible since the food is a substitute for regular food and meets normal nutritional needs. Ineligible Foot Care (non-medicated) The cost of non-medicated foot care products is an eligible medical expense. Non-medicated foot care include, but are not limited to: callous removers, bunion treatments, non-medicated blister care products. The cost of custom made and over the counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense. Eligible Foot Care (over-the-counter) The cost of an OTC foot care product is an eligible medical expense. OTC products include, but are not limited to: medicated blister care, medicated callous removers, corn & callous treatments. EligibleForms Completion
Charges incurred for provider completion of forms is not an eligible medical expense. Including, but not limited to the following examples: disability form, FMLA form, sports participation form, camp formIneligible
Founder’s Fees
A lifetime care advance payment (also known as a founder's fee) is not an eligible medical expense. Ineligible Fuel, Gasoline for Medical Care The cost of fuel/gas primarily for and essential to medical care, is an eligible medical expense. Fuel/gas expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2020, the eligible rate is $0.17 per mile (effective 1/1/2020). For 2019, the eligible rate is $.20 per mile (effective 1/1/2019). Note: Long-distance travel cannot be for purely personal reasons. EligibleFuneral Expenses
The cost of a funeral is not an eligible medical expense. IneligibleGambling Treatment
A health care professional must provide evidence of medical necessity for the cost of gambling treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Gastric Bypass Surgery Including Excess Skin Removal (for cosmeticreasons)
The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Gastric Bypass Surgery Including Excess Skin Removal (for medicalcondition)
A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Gastric Bypass Surgery Including Excess Skin Removal (for obesitytreatment)
The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of thesesurgeries. Eligible
Gauze Pads
Gauze pads are an eligible medical expense. EligibleGenetic Testing
The cost of genetic testing to identify the potential for, or existence of, a medical condition (such as a test for the breast cancer gene) is an eligible medical expense. However, the cost of a DNA test to determine paternity is not an eligible medical expense.Eligible
GIFT (Gamete intrafallopian transfer) When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as you, your spouse or a eligible dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Glucosamine and Glucosamine Chondroitin The cost of Glucosamine and Glucosamine Chondroitin is an eligible medical expense. Eligible Glucose Monitoring Device Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs. EligibleGlucose Tabs
Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs. Eligible Goggles (prescription) The cost of prescription eyeglasses, prescription sunglasses, eye exams, eye patches, reading glasses, OTC reading glasses, tinting of prescription eyewear, prescription goggles and prescription safety glasses are eligible medical expenses. This also includes but not limited to: cataract surgery, Lasik surgery, Corneal Rings. EligibleGuide Dog
The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses. EligibleGynecologist
The cost of gynecological care is an eligible medical expense.Eligible
Hair Removal or Transplant (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Hair Removal or Transplant (for medical condition) A health care professional must provide evidence of medical necessity for the cost of hair removal or a hair transplant to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredHalf Way House
A health care professional must provide evidence of medical necessity for the cost of treatment for alcoholism or substance abuse in a Half Way House to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Handicap, Disability Placards and License Plates The cost of handicap license plates/placards is an eligible medicalexpense. Eligible
HDHP, High-deductible health plan (premiums) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a high-deductible health plan (HDHP) and premiums paid as part of a Section 125 payroll reduction plan, are not eligible medical expenses. IneligibleHeadache Medicine
The cost of an OTC headache medicine is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Anacin, Aspirin, Doan’s, Excedrin, HeadOn, IMAK, Motrin, Tylenol. Eligible Health Club or Gym Membership Fees (for general health/non-medical) Health club dues paid for general health or to relieve physical or mental discomfort not related to a medical condition are not eligible medical expenses. Ineligible Health Club or Gym Membership Fees (for medical condition) A health care professional must provide evidence of medical necessity for the cost of dues paid to a health club or gym to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is only for the individual membership and for the component that is related to the current plan year. Any dues that carry over to another plan year must be submitted for that plan year of coverage. Even if you're required to prepay for an entire year, membership fees may only be reimbursed each month. RequiredHealth Screenings
The cost of health screenings/preventive care screenings is an eligible medical expense. Preventive care includes but is not limited to: blood pressure, glaucoma, cataracts, hearing, cholesterol, life line screenings. The cost of a body scan (e.g., an MRI,PET,CAT) and amounts paid for diagnostic services are also eligible medicalexpenses. Eligible
Hearing Aids and Batteries Amounts paid for a hearing aid and hearing aid batteries are eligible medical expenses. This also includes a hearing aid remote control (to adjust the volume) and a dehumidifier or sanitizer for the hearing aid. Repairs for the hearing aid are also eligible medical expenses.Eligible
Heart Rate Monitors
Cost of a heart rate monitor is an eligible medical expense. EligibleHeating Pads
When used for medical purposes, the cost of a heating pad, hot pack or cold pack is an eligible medical expense. Eligible Hemorrhoid Treatment The cost of an OTC hemorrhoid treatment is an eligible medical expense. OTC products include, but are not limited to: Fleet, Preparation H, Tronolane, Tucks. Eligible Herbs and Herbal Supplement (for general health) When herbs or herbal supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for herbs or herbal supplements are not eligible medical expenses. Ineligible Herbs and Herbal Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required HMO, Health Maintenance Organization (premiums) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible medical expenses. Ineligible Holistic, Homeopathic Professional (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Ineligible Holistic, Homeopathic Professional (for medical condition) Treatments provided by non-traditional alternative healer professionals (like holistic, homepathic professionals) are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition. Required Home Diagnostic Kits, Tests, Devices The cost of a home diagnostic kit, test or device is an eligible medical expense. Examples include, but are not limited to: blood pressure monitors, cholesterol tests, colorectal screenings, diabetic equipment and supplies, pregnancy tests. EligibleHome Health Care
Wages and other amounts paid for nursing services associated with caring for the participant, spouse or tax-qualified dependent’s medical condition (dispensing medications, changing dressings, attention and care to wounds, monitor vital signs, record and document assessment results, bathing and grooming the patient, etc.) are eligible medical expenses. Note: Only amounts paid for nursing services are eligible medical expenses. If the attendant also provides personal and household services, these amounts must be divided between the time spent performing household/personal services and the time spent for nursing services. EligibleHome Improvements
A health care professional must provide evidence of medical necessity for the cost of home improvement to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov . Required Homeopathic Care and Medicines Treatments provided by non-traditional alternative healer professionals (like homeopathic care and medicines) are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition. Required Homeopathic Care and Medicines (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Ineligible Hormone Replacement Therapy (HRT) (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Hormone Replacement Therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Hormone Replacement Therapy (HRT) (used as an enhancement) Hormone replacements used as an enhancement for body-builders, athletes and others are not eligible medical expenses. Ineligible Hospice Care/Palliative Care Amounts paid for hospice care or palliative care is an eligible medical expense EligibleHospital Services
Amounts paid for hospital services are eligible medical expenses. Amounts paid for ancillary hospital services (such as an upgrade from a semi-private to private room or fees charged for parents to stay with a child) are eligible medical expenses. EligibleHousehold Help
The cost of household help, even if recommended by a health care professional, is not an eligible medical expense. However, amounts paid for nursing services are eligible medical expenses. IneligibleHuman Guide
To assist a physically, visually, hearing or mentally impaired person, fees paid for a human guide are eligible medical expenses. Eligible Humidifier (for medical care) The cost of a vaporizer or humidifier for medical care is an eligible medical expense. EligibleHydrotherapy
A health care professional must provide evidence of medical necessity for the cost of hydrotherapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Hyperbaric Oxygen Therapy A health care professional must provide evidence of medical necessity for the cost of hyperbaric oxygen to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredHypnosis
A health care professional must provide evidence of medical necessity for the cost of hypnosis to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Illegal Operations, Illegal Treatments The cost of an illegal operation or other treatment is not an eligible medical expense. IneligibleImmunizations
The cost of a vaccination and immunization is an eligible medical expense. This includes, but is not limited to: an immunization required for travel, Gardasil and HPV vaccinations. EligibleImpotence
A health care professional must provide evidence of medical necessity for the cost of treatment for impotence or sexual dysfunction (male or female) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
In Vitro Fertilization When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Inclinator
A health care professional must provide evidence of medical necessity for the cost of an inclinator to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Incontinence Products The cost of an incontinence product is an eligible medical expense. Examples include, but are not limited to: Depend, Invacare, Poise, Prevail, Serenity. Eligible Infertility Treatments When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Injection Snore Plasty A health care professional must provide evidence of medical necessity for the cost of snore plasty to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Insect Bite Cream, Ointment The cost of an OTC insect bite treatment is an eligible medical expense. OTC products include, but are not limited to: After Bite, Benadryl, Calamine lotion, Cortaid, Cortizone, Lanacane, Mitigator.Eligible
Insulin
The cost of insulin is an eligible medical expense. Eligible Insurance Premiums (for Medicare supplement policies) Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Ineligible Insurance Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Insurance Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. EligibleInversion Table
A health care professional must provide evidence of medical necessity for the cost of an inversion table to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Investigational Surgery The cost of investigational surgery is an eligible medical expense.Eligible
Invisalign Orthodontics The cost of orthodontia care (including braces and invisalign) is an eligible medical expense. Eligible Joint Supplement (for general health) When joint supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for joint supplements are not eligible medical expenses. Ineligible Joint Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of joint supplements to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Kenalog Injections (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Kenalog injections (for medical condition) A health care professional must provide evidence of medical necessity for the cost of kenalog injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredKenesio Tape
The cost of kenesio tape is an eligible medical expense since it allows the body and muscles to move while assisting in rehabilitation.Eligible
Kinesiology
A health care professional must provide evidence of medical necessity for the cost of kinesiology to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredLaboratory Fees
Laboratory fees are eligible medical expenses. Eligible Lactation Aids and Supplies The cost of lactation aids (e.g., breast milk transport bag, freezing/storage packs, nursing/pumping bra, nursing pads) are eligible medical expenses. Eligible Lactation Consultant When needed for a woman experiencing lactation problems (such as being unable to breast feed,) the cost of a lactation consultant is an eligible medical expense EligibleLaetrile
A health care professional must provide evidence of medical necessity for the cost of laetrile (sometimes called vitamin B17) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Lamaze Classes (not related to the actual childbirth) The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breast feeding vs. bottle feeding, newborn care) is not an eligible medical expense. Ineligible Lamaze Classes (related to childbirth) Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for thatportion. Eligible
Language Classes
A health care professional must provide evidence of medical necessity for the cost of language classes to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Lap Band Surgery (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Lap Band Surgery (for medical condition) A health care professional must provide evidence of medical necessity for lap band surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Lap Band Surgery (for obesity treatment) The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of thesesurgeries. Eligible
LASIK, Laser Eye Surgery The cost of LASIK/PRK or radial keratotomy surgery is an eligible medical expense. EligibleLate Payment Fee
A late fee associated with a medical payment is not an eligible medical expense. IneligibleLaxatives
The cost of an OTC laxative is an eligible medical expense. OTC products include, but are not limited to: Correctol, Dulcolax, Ex-lax, Milk of Magnesia, Senokot. Eligible Lead Paint Correction (repaint affected area) The cost to repaint the affected area is not a eligible medicalexpense. Ineligible
Lead Paint Removal (for medical condition) A health care professional must provide evidence of medical necessity for the cost of lead paint removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Learning Disabilities A health care professional must provide evidence of medical necessity for the cost of special schools/programs for the learning disability to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a school/program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments to a special school/program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect. Required Legal Fees (for adoption) Legal fees for adoption are not eligible medical expenses. Ineligible Legal Fees (for divorce) Legal fees to obtain a divorce are not eligible medical expenses.Ineligible
Legal Fees (for fertility treatment) Legal fees in connection with fertility treatments for you, your spouse or dependent, if preparatory to the procedure are eligible medical expenses. Eligible Legal Fees (for guardian/estate) Guardianship and estate management fees are not eligible medicalexpenses Ineligible
Legal Fees (for surrogate mother) Legal fees in connection with a surrogate mother are not eligible medical expenses. Ineligible Legal Fees (to authorize treatment) To authorize treatment for a mentally ill patient, legal fees are eligible medical expenses. Eligible Lessons (for medical condition) A health care professional must provide evidence of medical necessity for the cost of fees paid for lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Lessons (non-medical) Fees paid for lessons not recommended by a health care professional or not specific to a medical condition are not eligible medical expensesIneligible
Lice Treatment and Removal (fees paid to specialist) Fees paid for a lice removal services performed by a lice treatment specialist in your home are eligible medical expenses. Eligible Lice Treatment and Removal (over-the-counter) The cost of an OTC lice treatment is an eligible medical expense. OTC products include, but are not limited to: Nex, Rid. Eligible Life Alert Emergency Medical Alert System The cost of a life alert emergency medical alert system is an eligible medical expense. EligibleLife Coach
A health care professional must provide evidence of medical necessity for the cost of a life coach to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Lip Balm (SPF 15 or higher) The cost of lip balm (regular/standard or medicated) with an SPF 15 or higher is an eligible medical expense. Eligible Lip Balm (SPF lower than 15) The cost of lip balm (regular/standard or medicated) with no SPF or an SPF lower than 15 is not an eligible medical expense. Ineligible Liposuction (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Liposuction (for medical condition) A health care professional must provide evidence of medical necessity for liposuction to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Liquid Adhesive Bandage for Small Cuts Liquid adhesive bandage for small cuts is an eligible medical expense.Eligible
Lodging and Trips (for general health) Amounts paid for a trip or vacation taken for a change in environment, improvement of morale or general improvement of health, even if recommended by a doctor, are not eligible medical expenses. Ineligible Lodging and Trips (to receive medical care) When the main reason for being in a hospital or other institution is to receive medical care, the cost of lodging, including meals, provided by the hospital are eligible medical expenses. Note: While you're away from home and receiving medical care, you may include lodging costs for the patient and a necessary traveling companion (e.g., parent with sick child or travel to be with a sick spouse), up to $50 per person, per night for lodging (maximum $100 per night). However, the lodging must be primarily for and essential to medical care; the medical care must be provided by a doctor in a licensed hospital or medical care facility related to, or the equivalent of, a licensed hospital; the lodging cannot be lavish or extravagant under the circumstances. There shouldn't be a significant element of personal pleasure, recreation or vacation in the travel away fromhome. Eligible
Long Term Care Insurance Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Long Term Care Insurance Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Eligible Long Term Care Services The cost of the medical portion only of care in a long term care facility is an eligible medical expense. Eligible Long Term Disability (LTD) Insurance Premiums (if you have a healthcare FSA)
Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Long Term Disability (LTD) Insurance Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. EligibleLumbar Support
A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredMarijuana
The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible. IneligibleMarriage Counseling
Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses. Ineligible Massage Therapy (for general health) The cost of massage therapy that is for general health is not an eligible medical expense. Ineligible Massage Therapy (for medical condition) A health care professional must provide evidence of medical necessity for the cost of massage therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Mastectomy-Related Expenses Each of the following mastectomy-related expenses is an eligible medical expense: 1) the cost of a breast prosthesis; 2) the cost of a bra or other clothing (such as a sports bra or bathing suit) designed to hold the breast prosthesis. Note: the eligible expense includes only the amount above the cost of the product in its standard form; 3) the cost of a special bra or other clothing with built in breast prosthesis. EligibleMaternity Aids
Cost of certain maternity items is an eligible medial expense. Eligible items include, but are not limited to: products that reduce discomfort associated with pregnancy such as maternity girdle and maternity support belts. EligibleMaternity Charges
Amounts paid to a physician or licensed midwife for delivery charges are eligible medical expenses. EligibleMaternity Clothes
The cost of maternity clothing is not an eligible medical expense.Ineligible
Mattress
A health care professional must provide evidence of medical necessity for the cost of a mattress to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimburssement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Only the amount that exceeds the cost of a regular mattress is reimbursable. We reimburse the cost difference between the standard product and specialty product. The member needs to provide the cost difference (e.g., sales flyer) of a standard mattress for us to reimburse the difference between thecosts. Required
Meals (for a companion) Amounts paid for the meals for a companion are not eligible medical expenses. Ineligible Meals (for inpatient care) Amounts paid for meals associated with inpatient medical care is an eligible medical expense. Eligible Medical Alert Bracelet, Necklace The cost of alert jewelry and membership fees associated with the jewelry are eligible expenses. Eligible Medical Care Outside U.S. The cost of legal medical care received outside the U.S. is an eligible medical expense. Note: The medical care must be legal in the foreign country and in the U.S. (had it been provided here). Eligible Medical Conference (admission and transportation) A health care professional must provide evidence of medical necessity for the cost of admission and transportation to the conference to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the medical conference is required for the treatment of a medical condition of the account holder or a qualified dependent. Required Medical Information Storage Plan The cost to store medical information in and to be able to retrieve that information from a computer data bank, is an eligible medicalexpense. Eligible
Medical Monitoring, Testing Devices The cost of a medical monitoring or testing device (e.g., to test blood pressure, blood sugar, cholesterol, heart, etc.) is an eligible medical expense. EligibleMedical Newsletter
The cost of a medical newsletter is not an eligible medical expense. A newsletter does not directly treat a medical condition. IneligibleMedical Records
The cost of transferring or copying medical records is an eligible medical expense. Eligible Medical Services (monthly/annual fee) The cost of a monthly or annual fee for services even if they are never used, is not an eligible medical expense. Ineligible Medical Services (payment for treatment of medical condition) Amounts paid to physicians, surgeons, specialists and other medical practitioners for treatment of medical conditions are eligible medical expenses. Eligible Medical Services (phone consultation) The cost of a phone consultation with a Medical provider is an eligible medical expense. This includes TelaDoc services. Eligible Medical Services (virtual office visits) The cost of virtual office visits is an eligible medical expense, since they are doctor-patient interactions that may occur via email or through a Web-based portal. They offer patients an alternative way to communicate with their physician regarding health issues that do not require face-to-face contact such as routine follow-ups. These expenses are eligible on a per visit basis. Eligible Medicare Parts A, B and D (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Medicare Parts A, B and D (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Eligible Medicated Lip Product (for cold sore/fever blister) The cost of an OTC cold sore or fever blister product is an eligible medical expense. OTC products include, but are not limited to: Abreva Cream, Herpecin. Eligible Medicated Lip Product (lip balm lower than SPF 15) The cost of medicated lip balm with no SPF or an SPF lower than 15 is not an eligible medical expense. Ineligible Medicated Lip Product (lip balm SPF 15 or higher) The cost of medicated lip balm with an SPF 15 or higher is an eligible medical expense. Eligible Medicine and Drugs from Other Countries (purchased and consumed inanother country)
The cost of prescription medicine purchased and consumed in another country (such as while on vacation or living as an expatriate) is an eligible medical expense, if the drug is legal in both the other country and the U.S. Eligible Medicine and Drugs from Other Countries (purchased in another countryfor use in U.S.)
The cost of medicine or drugs purchased from another country for use in this country is not an eligible medical expense, unless the Food and Drug Administration (FDA) announces that a prescribed drug can be legally imported by individuals. Ineligible Medicine and Drugs, Over-the-Counter (OTC) The cost of an OTC product, drug or medicine is an eligible medicalexpense. Eligible
Medicine, Prescription The cost of a prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees. Eligible Medicine, Prescription (for cosmetic reasons) The cost of prescriptions for cosmetics drugs are not an eligible medical expense. IneligibleMediscope
The cost of a medical device used to provide bright illumination during an examination of ears, nose and throat is an eligible medicalexpense. Eligible
Menstrual Pain Reliever The cost of an OTC menstrual pain reliever is an eligible medical expense. OTC products include, but are not limited to: Diurex, Midol, Motrin, Pamprin. Eligible Mentally Challenged, Special Home The cost of a special home (not the home of a relative) to make the transition from a mental hospital to community living is an eligible medical expense. Eligible Micro-Dermabrasion (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. IneligibleMidwife
Amounts paid for a midwife are eligible medical expenses. Eligible Migraine Relief (over-the-counter) The cost of an OTC pain relievers is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Aspirin, BenGay, Capzasin, Castiva, Motrin, Tylenol, Zostrix. Eligible Mileage (primarily for medical care) The cost of mileage primarily for and essential to medical care, is an eligible medical expense. Mileage fees are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2020, the eligible rate is $0.17 per mile (effective 1/1/2020). For 2019, the eligible rate is $.20 per mile (effective 1/1/2019). Note: Long-distance travel cannot be for purely personal reasons. Eligible Minerals, Mineral Supplement (for general health) When minerals or mineral supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for minerals or mineral supplements are not eligible medical expenses. Ineligible Minerals, Mineral Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of minerals or mineral supplements to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Missed Appointment Fees A fee paid for a missed appointment is not an eligible medical expense. IneligibleMonitor
The cost of a medical monitoring or testing device (e.g., to test blood pressure, blood sugar, cholesterol, heart, etc.) is an eligible medical expense. Eligible Morning-After Contraception Pill The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. EligibleMotion Sickness
The cost of an OTC motion sickness product is an eligible medical expense. OTC products include, but are not limited to: Bonine, Dramamine, Emetrol, Meclizine. EligibleMouth Guard
The cost of a Mouth Guard is an eligible medical expense. This is true for prescription and OTC. EligibleNasal Aspirator
The cost of a nasal aspirator is an eligible medical expense. OTC products include, but are not limited to: NoseFrida Eligible Nasal Sprays, Nasal Solutions The cost of an OTC nasal spray or solution is an eligible medical expense. OTC products include, but are not limited to: 4-Way, Afrin, Ayr, ENTSOL, Nasal Crom, Neo-Synephrine, Nostrilla, Simply Saline,Vicks. Eligible
Nasal Strips
The cost of Nasal Strips to alleviate snoring or reduce nasal congestion is a qualified medical expense. OTC products include, but are no limited to: Breathe Clear, Breathe Right, nose cones, Snorezz.Eligible
Natural Lens Replacement The cost of this FDA approved procedure where the patient’s lens is removed and replaced with a clear plastic lens that allows him or her to focus more accurately is an eligible medical expense. Eligible Naturopathic Care, Naturopathic Healers (for general health) Alternative treatments, healers, drugs and medicines for general health are not eligible expenses. Ineligible Naturopathic Care, Naturopathic Healers (for medical condition) Treatments provided by non-traditional alternative healer professionals (like naturopathic care and healers) are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition. Required Naturopathic Healers Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition.Eligible
Nebulizer
The cost of a nebulizer or peak flow meter is an eligible medicalexpense. Eligible
Neti Pot
The cost of a neti pot used for sinus and allergy relief is an eligible medical expense. EligibleNeurologist
The cost of neurological care is an eligible medical expense. Eligible Newborn Nursing Care Cost for nursing care services of a healthy infant are not an eligible medical expense. Ineligible Nicotine Gum and Patches The cost of an OTC nicotine gum and patch is an eligible medical expense. OTC products include, but are not limited to: nicotine gum and patches. Eligible Non-Prescription Drugs, Medicines The cost of an over-the-counter (OTC) product, drug or medicine is an eligible medical expense. Eligible Norplant insertion or removal The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. Eligible NSAIDS (over-the-counter) The cost of an OTC pain reliever is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Aspirin, BenGay, Capzasin, Castiva, Motrin, Tylenol, Zostrix. Eligible Nursing Home (medical care, meals and lodging) A health care professional must provide evidence of medical necessity for the cost of medical care provided during a temporary stay in a convalescent, nursing home or skilled facility, (e.g., following a hospital stay or surgery) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the convalescent/nursing home if the main reason for being there is to receive medical care in order to return home. If participant resides permanently in the facility, only separately stated medical expenses would be eligible for reimbursement (e.g. individually billed doctor visits; prescription costs). The cost of custodial care in a convalescent or nursing home (e.g., long term care) is not an eligible medical expense. Required Nursing Pillows or Covers The cost of nursing pillows or other personal items and accessories are not eligible medical expenses. This includes but is not limited to: nursing covers, Boppy pillow, etc. Ineligible Nursing services provided at home Wages and other amounts paid for nursing services associated with caring for the participant, spouse or tax-qualified dependent’s medical condition (dispensing medications, changing dressings, attention and care to wounds, monitor vital signs, record and document assessment results, bathing and grooming the patient, etc.) are eligible medical expenses. Note: Only amounts paid for nursing services are eligible medical expenses. If the attendant also provides personal and household services, these amounts must be divided between the time spent performing household/personal services and the time spent for nursing services. EligibleNursing Supplies
Nursing supplies are the equipment and disposable supplies that assist with breastfeeding or nursing. The cost of those supplies are eligible medical expenses. This includes but is not limited to: breast pumps, disposable bra pads, lanolin cream, breastfeeding tubes and containers. Eligible Nutritional Supplement (for general health) When nutritional supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for nutritional supplements are not eligible medical expenses. Ineligible Nutritional Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of nutritional supplements to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Nutritionist (for general well-being) Amounts paid to a nutritionist for general well-being, even when recommended by a health care professional, are not eligible medical expenses. Ineligible Nutritionist (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a nutritionist to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredObstetrical Care
The cost of obstetrical care is an eligible medical expense. Documentation requires an Explanation of Benefits (EOB) or itemized statement of the birth expenses. Note: Copay amounts and tests performed during the pregnancy (i.e., ultrasound) would be considered eligible when the expense is incurred, if billed separately. Eligible Obstetrical Care (prepaid expenses for the birth) Prepaid expenses for the birth are not eligible until the baby is born and insurance has paid. The incurred date is considered the date of birth to avoid overpayment situations and crossing of plan years.Ineligible
Occlusal Guard
The cost of a occlusal or mouth guard is an eligible medical expense. This is true for prescription and over-the-counter. Eligible Occupational Therapy The cost of occupational therapy is an eligible medical expense.Eligible
Oncologist
Fees paid to an oncologist are eligible medical expenses. Eligible Operation (for cosmetic reasons) The cost of cosmetic surgery is not an eligible medical expense.Ineligible
Operation (for medical care) The cost of a legal operation required for medical care performed legally in the U.S. or performed legally in another country (and which would be legal if performed in the U.S.) is an eligible medicalexpense. Eligible
Ophthalmologist
Amounts paid to an ophthalmologist are eligible medical expenses.Eligible
Optometrist
Amounts paid to an optometrist are eligible medical expenses. Eligible Organ Donor Expenses (paid by donor) Expenses for services received by the donor are eligible medical expenses, if paid by the donor. Eligible Organ Donor/Recipient Expenses (paid by recipient) The expenses related to the recipient or donor are eligible as long as the recipient is responsible for the services received and is covered by a health care FSA, HSA or HRA. Eligible Organ Recipient Expenses (paid by the donor) Expenses related to the organ recipient and paid by the donor are not eligible medical expenses, if they are not covered by a health care FSA, HSA or HRA. IneligibleOrthodontia
The cost of orthodontia care (including braces and invisalign) is an eligible medical expense. EligibleOrthokeratology
Cost for orthokeratology (also known as corneal molding) is an eligible medical expense. It is a surgical procedure similar to Lasik Surgery to improve or correct near sightedness, far sightedness and astigmatism. EligibleOrthopedic Shoes
A health care professional must provide evidence of medical necessity for the cost of orthopedic shoes to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Only the cost difference of the specialized orthopedic shoe over the cost of an equivalent regular shoe is eligible. RequiredOrthotics
The cost of custom made and over-the-counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense. Eligible OSHA Handling Fees for Bio-Hazards Waste Disposal. Fees paid for Bio-Hazard Waste Disposal for the Safe disposal of Potential Blood Borne Pathogen, Sharps and Related Bio-Hazardous Waste are eligible medical expenses. Some doctors and dentists may itemize these on their invoices. EligibleOsteopath
The cost of osteopathic care is an eligible medical expense. Eligible Ostomy, Colostomy Supplies Amounts paid for items such as pouches, lubricants, deodorants, support garments, etc. are eligible medical expenses. Eligible OTC (over-the-counter) The cost of an OTC product, drug or medicine is an eligible medicalexpense. Eligible
Out-of-Network Provider Costs incurred by the member for expenses not covered by insurance and charged for using an out of network provider are eligible medicalexpenses. Eligible
Over-the-Counter (OTC) Drugs and Medicines The cost of an OTC product, drug or medicine is an eligible medicalexpense. Eligible
Over-the-Counter (OTC) Supplies Amounts paid for OTC supplies are eligible expenses. This includes but is not limited to: crutches, band-aids, and braces. EligibleOvulation Monitor
The cost of an ovulation monitor is an eligible medical expense.Eligible
Oxygen
Amounts paid, including rental fees, for oxygen and oxygen equipment are eligible medical expenses. Eligible Pain Relievers (Over-the-counter) The cost of an OTC pain relievers is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Aspirin, BenGay, Capzasin, Castiva, Motrin, Tylenol, Zostrix. Eligible Parking Fees (primarily for medical care) The cost of parking fees primarily for and essential to medical care, is an eligible medical expense. Parking fees are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement.Eligible
Particulate Respirator Mask The cost of a surgical mask is an eligible medical expense. EligiblePastoral Counseling
Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses. IneligiblePaternity Testing
The cost of a DNA test to determine paternity is not an eligible medical expense Ineligible Patterning Exercises Costs to hire an individual to perform patterning exercises are qualified medical expenses. EligiblePeak Flow Meter
The cost of a nebulizer or peak flow meter is an eligible medicalexpense. Eligible
Pediculicide/Lice Treatment The cost of an OTC lice treatment is an eligible medical expense. OTC products include, but are not limited to: Nex, Rid. Fees paid for a lice removal services performed by a lice treatment specialist in your home are also eligible medical expenses. EligiblePedometer
A health care professional must provide evidence of medical necessity for the cost of a pedometer to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredPenile Implants
A health care professional must provide evidence of medical necessity for penile implants to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredPersonal Items
Products used for personal grooming and hygiene are not eligible medical expenses. Ineligible Personal Trainer Fees (for general health) Fees paid to a personal trainer for improvement of general health (even when recommended by a health care professional) are not eligible medical expenses. Ineligible Personal Trainer Fees (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a personal trainer to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredPET Scan
Cost for a PET scan which is a nuclear medicine imaging technique is an eligible medical expense. EligiblePetroleum Jelly
The cost of an OTC petroleum jelly product is an eligible medical expense. Petroleum jelly protects minor cuts, burns, skin protectant, heals skin. Eligible Phone Consultation with Doctor The cost of a phone consultation with a Medical provider is an eligible medical expense. This includes TelaDoc services. EligiblePhototherapy
A health care professional must provide evidence of medical necessity for the cost of phototherapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredPhysical exam
The cost of a physical exam is an eligible medical expense. Note: Work-related physical exams are eligible UNLESS the examination is paid by the employer. Eligible Physical Exam for Caregiver The cost of a physical exam for a potential caregiver is not an eligible medical expense. IneligiblePhysical Therapy
The cost of physical therapy is an eligible medical expense. Eligible Physician Fees, Pre-Paid The cost of prepaid physician fees to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care is needed.Ineligible
Pill Cutters, Pill Box, Pill Sorters and Pill Organizers The cost of a pill cutter or accessories is an eligible medicalexpense. Eligible
Pillows for Lumbar and Cervical Support A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Post Mastectomy Clothing Each of the following mastectomy-related expenses is an eligible medical expense: 1) the cost of a breast prosthesis; 2) the cost of a bra or other clothing (such as a sports bra or bathing suit) designed to hold the breast prosthesis. Note: the eligible expense includes only the amount above the cost of the product in its standard form; 3) the cost of a special bra of other clothing with built in breast prosthesis. Eligible Pre-Existing Condition Medical costs not covered by the medical plan due to the plan’s limitation on pre-existing conditions is an eligible medical expenses. Eligible Pregnancy and Delivery Charges The cost of obstetrical care is an eligible medical expense. Documentation requires an Explanation of Benefits (EOB) or itemized statement of the birth expenses. Note: Copay amounts and tests performed during the pregnancy (i.e., ultrasound) would be considered eligible when the expense is incurred, if billed separately. Prepaid expenses for the birth are not eligible until the baby is born and insurance has paid. The incurred date is considered the date of birth to avoid overpayment situations and crossing of plan years. Eligible Pregnancy Charges Paid Monthly per Contract Pregnancy charges paid monthly per contract are considered eligible when baby is born and after insurance pays. Documentation requires an Explanation of Benefits (EOB) or itemized statement of the birthexpenses. Eligible
Pregnancy Items
Cost of certain pregnancy items is an eligible medial expense. Eligible items include, but are not limited to: products that reduce discomfort associated with pregnancy such as maternity girdle and maternity support belts. Eligible Pregnancy Termination The cost of a legal abortion is an eligible medical expense. EligiblePregnancy Tests
The cost of a pregnancy test is an eligible medical expense. Eligible Premiums (for Medicare supplement policies) Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Ineligible Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. EligiblePrenatal Vitamins
The cost of Prenatal vitamins is an eligible medical expense. EligiblePre-Paid Payments
A prepayment for medical care is not reimbursable until you have received the care. Internal Revenue Service (IRS) guidelines require services to be incurred before expenses can be reimbursed.Ineligible
Prescription Drug Discount Program The costs to have access to reduced cost prescriptions are not eligible medical expenses. These are viewed as a type of insurance.Ineligible
Prescription Drugs, Medicines The cost of a medicine/prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees. The drug must be legal in the country where you purchased and used it. Eligible Preventative Care Screenings The cost of preventive care screenings is an eligible medical expense. Preventive care includes but is not limited to: blood pressure, glaucoma, cataracts, hearing, cholesterol, life line screenings.Eligible
Preventive Care Services The cost of preventive care is an eligible medical expense. Preventive care includes but is not limited to: Periodic health evaluations, including tests and diagnostic procedures in connection with routine examinations (e.g., annual physicals), routine prenatal and well-child care, child and adult immunizations, certain screening services.Eligible
Private Hospital Room The extra cost for a private hospital room is an eligible medicalexpense. Eligible
Probiotics (for general health) When probiotics are taken for general good health (even when recommended by a health care professional), the amounts paid for probiotics are not eligible medical expenses. Ineligible Probiotics (for medical condition) A health care professional must provide evidence of medical necessity for the cost of probiotics to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Progesterone, Testosterone Hormones (for cosmetic reasons) Progesterone or testosterone used for cosmetic purposes or body building are not an eligible medical expense. Ineligible Progesterone, Testosterone Hormones (for medical condition) A health care professional must provide evidence of medical necessity for the cost of progesterone and testosterone to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Propecia (for cosmetic reasons) Propecia used for cosmetic purposes is not an eligible medicalexpense. Ineligible
Propecia (for medical condition) A health care professional must provide evidence of medical necessity for the cost of propecia to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredProsthesis
Amount paid for the design and purchase of an artificial limb, eye or teeth is an eligible medical expense. Eligible Psychiatric Services and Care The cost of psychiatric care, including care in a specially equipped center for receiving medical care, is an eligible medical expense.Eligible
Psychoanalysis
Fees paid for Psychoanalysis are eligible medical expenses.Eligible
Psychologist
Fees paid for Psychologist are eligible medical expenses. EligiblePsychotherapist
Fees paid for Psychotherapy are eligible medical expenses. EligiblePsychotherapy
Fees paid for Psychotherapy are eligible medical expenses; this would include Individual and Family Psychotherapy. EligiblePulse Oximeter
The cost of a pulse oximeter which checks oxygen levels and pulse rates is an eligible medical expense. EligiblePurifier
A health care professional must provide evidence of medical necessity for the cost of a purifier to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredRadial Keratotomy
The cost of radial keratotomy is an eligible medical expense. EligibleReading Glasses
The cost of reading glasses is an eligible medical expense. Eligible Reasonable & Customary (R&C) Amounts that exceed R&C are eligible medical expenses. EligibleReflexology
A health care professional must provide evidence of medical necessity for the cost of reflexology to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Rehabilitation Center (custodial care for permanent residence) The cost of custodial care in a rehabilitation center or nursing home for permanent residence is not an eligible medical expense. Ineligible Rehabilitation Center (meals and lodging) A health care professional must provide evidence of medical necessity for the cost of follow-up medical care after a hospital stay, surgery or an injury at a rehabilitation center or facility to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the rehabilitation center if the main reason for being there is to receive medical care. Note: Lodging while receiving temporary care would be an eligible expense if the individual is receiving medical treatment and not their permanentresidence. Required
Respite Care
Amounts paid for respite care is an eligible medical expense Eligible Restylane Injections (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. IneligibleRetention Fees
The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care isneeded. Ineligible
Retin-A (for effects of aging) When prescribed for the effects of aging, the cost of Retin-A is not an eligible medical expense. Ineligible Retin-A (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Retin-A to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Rhinoplasty (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Rogaine (for cosmetic reasons) If used for cosmetic purposes, Rogaine is not an eligible medicalexpense. Ineligible
Rogaine (for medical condition) A health care professional must provide evidence of medical necessity for the cost of propecia to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Rolfing, Structural Integration A health care professional must provide evidence of medical necessity for the cost of rolfing to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Safety Glasses (Prescription) The cost of prescription safety glasses is an eligible medicalexpense. Eligible
Sales Tax
Sales tax incurred for a medical service or product (including OTC) are eligible medical expenses. Eligible Scale, food or weight A health care professional must provide evidence of medical necessity for the cost of a food scale or weight scale to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredSchools, Special
A health care professional must provide evidence of medical necessity for the cost of special and residential schools to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a school, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments to a special school are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect.Required
Screening Tests
The cost of screening tests is an eligible medical expense. These are considered preventive care and routine medical tests that can help detect diseases and medical conditions. It includes but is not limited to: blood pressure tests, cholesterol tests, colorectal cancer screening, diabetes tests, HIV tests, syphilis tests, bone mineral density tests, mammograms, cervical cancer screenings, and prostate cancer screenings. Eligible Seeing-eye Dog, Service Animal The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses. Eligible Services Not Covered by Insurance The cost of medical, dental and vision procedures and items that are not covered under any health plan you may have but are to treat a medical condition is an eligible medical expense. EligibleSexual Counseling
A health care professional must provide evidence of medical necessity for the cost of sexual therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredSexual Dysfunction
A health care professional must provide evidence of medical necessity for the cost of treatment for impotence or sexual dysfunction (male or female) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The cost for the treatment of erectile dysfunction is an eligible medical expense. This includes but not limited to prescribed medications: Viagra, Cialis, Levitra. RequiredShampoos and Soaps
Products used for personal grooming and hygiene (like shampoos and soaps) are not eligible medical expenses. IneligibleSharps Container
The cost of a containers used for the disposal of needles is an eligible medical expense. Eligible Shipping and Handling Shipping and handling fees associated with medical care (for contact lenses, mail-order drugs, etc.) are eligible medical expenses.Eligible
Sinus Medication
The cost of an OTC sinus medication is an eligible medical expense. OTC products include, but are not limited to: Advil, Alavert, Aleve, Benadryl, Chlor-Trimeton, Claritin, Excedrin, Mucinex, Sudafed, Tavist, Tylenol. EligibleSitz Bath
The cost of a sitz bath is an eligible medical expense. A sitz bath is one in which the person sits in water up to the hips. It promotes healing and symptom relief for conditions such as for hemorrhoids, rectal surgery and recent childbirth. Eligible Skin Tag Removal (for cosmetic reasons) If the procedure is for cosmetic purposes, skin tag removal is not an eligible medical expense. Ineligible Skin Tag Removal (for medical condition) A health care professional must provide evidence of medical necessity for the cost of skin tag removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Sleep Deprivation Treatment The cost of an OTC sleeping deprivation treatment is an eligible medical expense. OTC products include, but are not limited to: Nytol, Sominex, Unisom. Eligible Smoking Cessation Program and Medication The cost of a smoking cessation program is an eligible medicalexpense. Eligible
Smoking Cessation Program and Medication (over-the-counter) The cost of an OTC smoking cessation medication is an eligible medical expense. OTC products include, but are not limited to: Commit, Endit, Habitrol, NicoDerm, Nicorette, Smoke Away. EligibleSomnoplasty
The cost of somnoplasy is an eligible medical expense. Somnoplasty uses radio frequency to treat sleep apnea, chronic nasal obstruction, or habitual snoring that is a result of obstructed airways is an eligible medical expense. Eligible Special Computer Program for the Blind A health care professional must provide evidence of medical necessity for the cost of special computer programs for the blind to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The computer itself would not be covered because of the general purpose it could pose for all family members. RequiredSpecial Food
A health care professional must provide evidence of medical necessity for the cost of special foods to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The amount that is reimbursable is the cost difference of normal food and the amount paid for the specialized food. The participant must provide the cost difference. Keep in mind, special foods do not include diet food or meal replacements such as shakes for weight loss programs. Required Specialized Medical Equipment or Services The cost to purchase or rent specialized medical equipment or services/durable medical equipment is an eligible medical expense. This includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet. EligibleSpeech Therapy
Amount paid for Speech Therapy is an eligible medical expense.Eligible
Speech Therapy (dvds, videos, software) A health care professional must provide evidence of medical necessity for the cost of DVDs, videos or special software to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The cost of the computer, Wii, etc. is not an eligible medical expense. Required Sperm Storage (for medical reasons) A health care professional must provide evidence of medical necessity for the cost of sperm storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Cost to store sperm for future implantation where you have no medical condition, is not an eligible medical expense. Required Sperm Storage (for non-medical reasons) Storage fees paid for non-medical reasons or to preserve the sperm for future generations (such as for genetic information) are not eligible medical expenses. IneligibleSpermicide
The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. Eligible Stem Cell Harvesting or Storage (for medical reasons) A health care professional must provide evidence of medical necessity for the cost of harvesting and storing stem cells to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect and store stem cells would be an eligible medical expense. Required Stem Cell Harvesting or Storage (for non-medical reasons) Storage and harvesting fees paid for non-medical reasons or to preserve the stem cells for future use are not eligible medical expenses. Ineligible Stem Cell Injections A health care professional must provide evidence of medical necessity for the cost of stem cell injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Sterilization Procedure or Reversal The cost to obtain or reverse a sterilization is an eligible medicalexpense. Eligible
Stop-Smoking Program The cost of a smoking cessation or stop-smoking program is an eligible medical expense. Eligible Student Health Fee (cost of medical care) The cost of medical care is an eligible medical expense. Eligible Student Health Fee (fees/premium for program) Fees for belonging to the program or as premium for future health care needs are not eligible medical expenses. Ineligible Substance Abuse Treatment The cost of treatment at a center for substance abuse is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment. Eligible Subway Fare (primarily for medical care) The cost of subway fare primarily for and essential to medical care, is an eligible medical expense. Subway fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement.Eligible
Sunburn Cream, Ointment The cost of an OTC sunburn cream is an eligible medical expense. OTC products include, but are not limited to: Solarcaine, Water Jel.Eligible
Sunglasses (no vision correction) The cost for over-the-counter sunglasses (no vision correction) is not an eligible medical expense. Ineligible Sunglasses (with prescription) The cost of prescription sunglasses is an eligible medical expense.Eligible
Sunscreen (lower than SPF 15) The cost of an over-the-counter sunscreen product with SPF lower than 15 or for lotions and cosmetics that contains sunscreen is not an eligible medical expense. Ineligible Sunscreen (SPF 15 or higher) The cost of an over-the-counter sunscreen product with SPF 15 or higher is an eligible medical expense. Eligible Supplement (for general health) When supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for supplements, herbs, minerals, and vitamins are not eligible medical expenses. Ineligible Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Supplements include but are not limited to: dietary, fiber, joint, and nutritional. RequiredSupport Hose
The cost of support hose, also known as anti-embolism socks, compression socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense. EligibleSuppositories
The cost of an over-the-counter (OTC) laxative/suppository is an eligible medical expense. OTC products include, but are not limited to: Correctol, Dulcolax, Ex-lax, Milk of Magnesia, Senokot. Eligible Surgery (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Surgery (for medical care) The cost of a legal surgery/operation required for medical care performed legally in the U.S. or performed legally in another country (and which would be legal if performed in the U.S.) is an eligible medical expense. Eligible Surrogate Mother Fees (for medical expenses for the surrogate) If the plan participant is using a surrogate mother, the medical expenses incurred by the surrogate mother are not eligible medical expenses of the plan participant, since the surrogate mother is not a covered individual under the participant’s plan. Ineligible Surrogate Mother Fees (for medical expenses, if member is surrogate) If the plan participant is fulfilling the role of a surrogate mother, medical expenses not paid by insurance or the adoptive parents are eligible medical expenses. Eligible Surrogate Mother Fees (for search of surrogate) Fees paid to an agency to search for a surrogate mother are not eligible medical expenses. Ineligible Swimming Lessons (for medical condition) A health care professional must provide evidence of medical necessity for the cost of fees paid for swimming lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Swimming Lessons (non-medical) Fees paid for swimming lessons not recommended by a health care professional or not specific to a medical condition are not eligible medical expenses Ineligible Swimming Pool (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a swimming pool to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov . Required Swimming Pool (for recreation) The cost of a pool is not an eligible medical expense if the pool is used for recreation. Ineligible Syntonic Phototherapy A health care professional must provide evidence of medical necessity for the cost of syntonic phototherapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Tanning Salon Visits or Equipment (for cosmetic reasons/appearance) The cost of tanning salon sessions or equipment for personal use and appearance is not an eligible medical expense. Ineligible Tanning Salon Visits or Equipment (for medical condition) A health care professional must provide evidence of medical necessity for the cost of tanning salon sessions or equipment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Tattoo Removal (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Ineligible Taxes on Medical Services and Products Taxes (such as sales tax or a hospital bill surcharge) incurred for a medical service or product, including OTC, are eligible medical expenses. Eligible Taxi Fare (primarily for medical care) The cost of taxi fare primarily for and essential to medical care, is an eligible medical expense. Taxi fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Eligible Teething, Toothache Remedies The cost of an OTC toothache remedies is an eligible medical expense. OTC products include, but are not limited to: Anbesol, Orajel.Eligible
Telephone Consultation Fee A fee charged by a health care professional for a telephone consultation is an eligible medical expense. Note: The associated phone charge (e.g., a toll call charge) is also an eligible medicalexpense. Eligible
Telephone for Hearing Impaired (cost of phone in hospital/treatmentcenter)
The cost of a telephone while in a hospital or treatment center is not an eligible medical expense. Ineligible Telephone for Hearing Impaired (fees for enhancing/repairing a phone) Fees associated with enhancing a telephone to accommodate a hearing-impaired person or person with a disability are eligible medical expenses. Note: Repair fees that exceed the cost of a regular telephone is also an eligible medical expense. Eligible Television for Visually or Hearing Impaired (cost of TV in hospital/treatment center) The cost of a television while in a hospital or treatment center is not an eligible medical expense. Ineligible Television for Visually or Hearing Impaired (cost to modify TV or buynew)
To assist a visually or hearing-impaired person, the cost to modify a television (such as an adapter for a regular television) or purchase a specially equipped television is an eligible medical expense. Note: Only the amount that exceeds the cost of a regular television is an eligible medical expense. Eligible Temporary Continuation of Coverage (TCC) Premiums (if you have ahealth care FSA)
Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Temporary Continuation of Coverage (TCC) Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Eligible Therapy (for medical condition) The cost of therapy for a medical condition or physical therapy is an eligible medical expense. Eligible Therapy (marriage/family for non-medical reasons) Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses. Ineligible Thermacare Heat Wraps Amounts paid for thermacare heat wraps are eligible medical expenses.Eligible
Thermography
The cost for a thermography procedure is an eligible medical expense. Thermography is a painless non-invasive scan without radiation that allows the examiner to visualize and quantify changes in skin surface temperature. This is an alternative to a breast mammogram withradiation. Eligible
Thermometer
The cost of a thermometer for medical use (e.g., to take someone’s temperature) is an eligible medical expense. EligibleThroat Lozenges
The cost of OTC throat lozenges is an eligible medical expense. OTC products include, but are not limited to: Cepacol, Chloraseptic, Cold-Eeze, Halls, Sucrets, Vicks. Eligible Toiletries (Personal Hygiene) Amounts paid for toiletries (e.g., cologne, dental floss, deodorant, lotion, shaving cream, shampoo, soap, toothpaste, etc.) are not eligible medical expenses. Ineligible Toll Fees (primarily for medical care) Toll fees primarily for and essential to medical care, is an eligible medical expense. Toll fees are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. EligibleToothbrushes
The cost of a toothbrush (including a specialized or battery-powered toothbrush), even when recommended by a dentist for a medical condition, is not an eligible medical expense. Ineligible Topical Analgesics (Muscles and Arthritis) The cost of an OTC topical analgesic is an eligible medical expense. OTC products include, but are not limited to: Absorbine Jr., Aleve, Aspercreme, Tylenol Arthritis, Capzasin, Ultra Blue, Zostrix. EligibleTopical Steroids
The cost of an OTC topical steroid is an eligible medical expense. OTC products include, but are not limited to: topical gels, lotions and creams that contain hydrocortisone. Eligible Train Fare (primarily for medical care) The cost of train fare primarily for and essential to medical care, is an eligible medical expense. Train fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. EligibleTransplant
An organ transplant is an eligible medical expense. This includes the donor's expenses if the donor is covered by the health care FSA, HSAor HRA. Eligible
Transportation (for medical care) The cost of transportation primarily for and essential to medical care, is an eligible medical expense. Transportation expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Eligible expenses include but are not limited to: ambulance services, bus, parking fee, plane fare, taxi, or toll. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2020, the eligible rate is $0.17 per mile (effective 1/1/2020). For 2019, the eligible rate is $.20 per mile (effective 1/1/2019). Note: Long-distance travel cannot be for purely personal reasons. Eligible Transportation (for nurse or companion) The cost of a nurse or companion's transportation expeses may be an eligible medical expense, if recommended by a health care professional for a medical condition. You must include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify the medical condition and that the expense is for treatment of the medical condition of a covered individual that is unable to travel alone and requires the assistance of a nurse or companion (e.g., a parent or spouse).Required
Transportation (non-medical) Regular (non-medical) commuting costs for an individual with a physical disability are not eligible medical expenses. Ineligible Transportation (to attend Alcoholics Anonymous) A health care professional must provide evidence of medical necessity for the cost of fees and transportation to attend Alcoholics Anonymous (AA) meetings to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition. Required
Transportation Cost of Disabled Individual Commuting To and From Work A disabled individual's commuting costs to and from work are not eligible medical expenses. Ineligible Tri-Care Premiums (if you have a health care FSA) Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Ineligible Tri-Care Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Eligible Trips (for general health) Amounts paid for a trip or vacation taken for a change in environment, improvement of morale or general improvement of health (even if recommended by a doctor) are not eligible medical expenses. Ineligible Trips (to receive medical care) When the main reason for being in a hospital or other institution is to receive medical care, the cost of lodging, including meals, provided by the hospital are eligible medical expenses. Note: While you're away from home and receiving medical care, you may include lodging costs for the patient and a necessary traveling companion (e.g., parent with sick child or travel to be with a sick spouse), up to $50 per person, per night for lodging (maximum $100 per night). However, the lodging must be primarily for and essential to medical care; the medical care must be provided by a doctor in a licensed hospital or medical care facility related to, or the equivalent of, a licensed hospital; the lodging cannot be lavish or extravagant under the circumstances. There shouldn't be a significant element of personal pleasure, recreation or vacation in the travel away fromhome. Eligible
Tubal Ligation, Tubal Ligation Reversal The cost of a tubal ligation or tubal ligation reversal is an eligible medical expense. Eligible Tuition (for special school/program) A health care professional must provide evidence of medical necessity for the cost of special and residential schools/programs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments for a special program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school/program may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birthdefect. Required
Tummy Tuck
Generally, the cost of a Tummy Tuck is not an eligible medical expense. In order to be considered an eligible expense, a health care professional must provide evidence of medical necessity for the cost of removal of excess skin. You must include a doctor's note or Letter of Medical Necessity with your request for reimbursement. The doctor's note or LOMN must specifically state that the recommendation and expense is for treatment of the medical condition. IneligibleTutoring
Expenses for hiring a tutor may be eligible for reimbursement if you, your spouse or eligible dependent has been diagnosed with a learning disability caused by mental or physical impairments. This also includes nervous system disorders. Learning disabilities diagnosed by a medical professional can allow for the medical professional to write a Letter of Medical Necessity (LOMN) stating that a specially trained tutor is required to help the learning-disabled individual receive an education. Examples include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect. RequiredUltrasound
The cost of an ultrasound for medical care (including prenatal care) is an eligible medical expense. Eligible Ultrasound, Pre-Natal (non-medical request by patient) The cost of an ultrasound that is not ordered by a health care professional or is not intended to monitor the growth and condition of the fetus is not an eligible expense. Ineligible Ultrasound, Pre-Natal (to monitor growth/condition) The cost of an ultrasound ordered by a health care professional to monitor the growth and condition of the fetus is an eligible medical expense, even if the benefit plan does not provide reimbursement.Eligible
Umbilical Cord Blood (harvesting/storage for medical condition) A health care professional must provide evidence of medical necessity with the infant or other family member covered under the health care account, for the cost of harvesting and storing cord blood to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect, freeze and store umbilical cord blood would be an eligible medical expense. Required Umbilical Cord Blood (harvesting/storage for non-medical reasons) Storage and harvesting fees paid for non-medical reasons or to preserve the cord blood for future use are not eligible medical expenses. IneligibleUrinalysis
The cost of urinalysis for medical conditions, including but not limited to, court ordered drug and alcohol testing both in-home and doctor's office, is an eligible medical expense. Eligible Usual, Customary and Reasonable (UCR), Charges Above Amounts that exceed reasonable and customary charges are eligible medical expenses. EligibleUVR treatments
A health care professional must provide evidence of medical necessity for the cost of ultra violet light treatments to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredVaccinations
The cost of a vaccination and immunization is an eligible medical expense. This includes, but is not limited to: an immunization required for travel, Gardasil and HPV vaccinations. Eligible Vaporizer, Humidifier The cost of a vaporizer or humidifier for medical care is an eligible medical expense. Eligible Varicose Veins Treatment (for cosmetic reasons) The cost to remove varicose veins for cosmetic purposes is not an eligible medical expense. Ineligible Varicose Veins Treatment (for medical condition) A health care professional must provide evidence of medical necessity for the cost of varicose vein removal or treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Vasectomy, Vasectomy Reversal The cost of a vasectomy or vasectomy reversal is an eligible medicalexpense. Eligible
Veneers (for cosmetic reasons) The cost of cosmetic veneers is not an eligible medical expense.Ineligible
Veneers (non-cosmetic) The cost of non-cosmetic veneers is eligible medical expense. Eligible Veterinary Fees (for guide dog/animal) Amounts paid for the care of a specially trained animal are eligible medical expenses. EligibleVision Correction
The cost of LASIK, laser eye surgery and radial keratotomy surgery is an eligible medical expense. Eligible Vision Discount Programs Fees to have access to a vision network that offers discounted items and services are not eligible medical expenses. Ineligible Vitamin (for general health) When taken for general good health (even when recommended by a health care professional), amounts paid for supplements, herbs, minerals, and vitamins are not eligible medical expenses. Ineligible Vitamin (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. RequiredWalker
The cost of an autoette, wheelchair, electronic wheelchair or walker (including the cost of maintenance) is an eligible medical expense.Eligible
Warranty
The cost of a warranty for example for vision or hearing aid equipment is not an eligible medical expense. Ineligible Wart Removal Treatment The cost of an OTC wart removal treatment is an eligible medical expense. OTC products include, but are not limited to: Dr. Scholl’s, Compound W. EligibleWaterpik
Waterpiks, when prescribed by Licensed Dentist for a medical condition like gingivitis, may be reimbursable with a doctor's note or Letter of Medical Necessity (LOMN). Required Weight Loss Drugs, Medicines (over-the-counter for medical condition) A health care professional must provide evidence of medical necessity for the cost of over-the-counter (OTC) weight loss drugs, like Alli to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Required
Weight Loss Drugs, Medicines (prescribed) The cost for a weight-loss prescription is an eligible medicalexpense. Eligible
Weight Loss Programs (for general health) The cost of a weight loss program associated with general weight loss (even when recommended by a health care professional) is not an eligible medical expense. Ineligible Weight Loss Programs (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a weight loss program to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: This includes the cost of the class or meeting as well as the fees to join; not the food or books. The cost is eligible as each meeting or session is attended, or for the monthly membership pass. In other words, even if you prepay for the entire program (such as a 17-week pass), you may only get reimbursed as you complete each class. Required Well Baby, Well Child Care The cost of preventative and wellness checks is an eligible medicalexpense. Eligible
Wellness Scan
A wellness scan is an eligible medical expense. This is generally used to find signs of medical problems. EligibleWheelchair, Walker
The cost of an autoette, wheelchair, electronic wheelchair or walker (including the cost of maintenance) is an eligible medical expense.Eligible
Whirlpool Baths
A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as a whirlpool path) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov . Required Wig (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a wig and certain maintenance items like glue, wig tape or under cap to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Required Wig (styling or cleaning products) The cost for styling or cleaning products for a wig would be personal expenses and is not an eligible medical expense. Ineligible Work Related Physical Examination for the Employee Work related physical exams are eligible UNLESS the examination is paid by the employer. EligibleX-Ray
The cost of X-ray fees for medical care is an eligible medicalexpense. Eligible
Yeast Infection Medication The cost of an OTC yeast infection medicine is an eligible medical expense. OTC products include, but are not limited to: Monistat,Vagistat. Eligible
VIEW LIST BY ELIGIBILITY CATEGORY Eligible Required(Letter of Medical Necessity required) IneligibleEligible
Acne (over-the-counter item) The cost of an OTC acne medicine is an eligible medical expense. OTC products include, but are not limited to: Acne Free, Acnomel, Bye Bye Blemish, Clean & Clear, Clearasil, Murad Acne Complex Kit, Neutrogena Acne Treatment, OXY, Pro-active Solution, Stri-Dex, SAPZYT AcneTreatment.
Acne (services)
If the primary purpose is treatment of acne, acne services are eligible medical expenses.Acupuncture
The cost of acupuncture is an eligible medical expense.Adaptive Equipment
The cost to purchase or rent adaptive/durable medical equipment is an eligible medical expense. This includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet. Adoption Medical Expenses (for tax qualified dependents) If the child is a tax-qualified dependent at the time of service, medical expenses paid for a child prior to adoption are eligiblemedical expenses.
Air Fare (primarily for medical care) The cost of air fare primarily for and essential to medical care, is an eligible medical expense. Air fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons. Alcoholism, Drug Addiction Treatment The cost of treatment at a center for alcohol or drug addiction is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment.Allergy Medicine
The cost of an OTC allergy medicine is an eligible medical expense. OTC products include, but are not limited to: Benadryl, Claritin,Dimetapp, Zyrtec.
Alternative Healers
Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition.Ambulance Service
The fee paid for ambulance service is an eligible medical expense. Analgesics (painkillers), Antipyretics (fever reducers) The cost of an OTC analgesic is an eligible medical expense. OTC products include, but are not limited to: Advil, Aspirin, Midol, Naprosyn, Pamprin, Premsyn PMS, Tylenol, Aspercreme, BenGay, Icy Hot.Anesthesiology
Anesthesiology fees are eligible medical expenses Antacids, Acid Reducers The cost of an OTC antacid is an eligible medical expense. OTC products include, but are not limited to: Alka-Seltzer, Brioschi, Maalox, Milk of Magnesia, Mylanta, Pepto-Bismol, Prilosec. Antibiotics, topical The cost of an OTC antibiotic is an eligible medical expense. OTC products include, but are not limited to: Cortaid, Neosporin,Polysporin.
Anti-Diarrhea
The cost of an OTC anti-diarrhea product is an eligible medical expense. OTC products include, but are not limited to: Pepto Bismol, Imodium AD, Kaopectate. Anti-Embolism Socks, Stockings The cost of compression socks, also known as anti-embolism socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense.Anti-Fungal
The cost of an OTC anti-fungal product is an eligible medical expense. OTC products include, but are not limited to: Lamisil AT, Lotrimin AF,Micatin.
Anti-Gas
The cost of an OTC anti-gas product is an eligible medical expense. OTC products include, but are not limited to: Mylanta, Gelusil,Phazyme, Gas-X.
Antihistamines
The cost of an OTC antihistamine is an eligible medical expense. OTC products include, but are not limited to: Benadryl, Claritin, Contac, Dimetapp, Sudafed, Triaminic.Anti-Itch
The cost of an OTC anti-itch product is an eligible medical expense. OTC products include, but are not limited to: Aveeno/Gold Bond Anti-Itch, Benadryl, Cortaid, Calamine lotion, Cortizone, Lanacane. Arch and Insole Support The cost of custom made and over the counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense.Arthritis Care
The cost of an OTC arthritis medicine is an eligible medical expense. OTC products include, but are not limited to: Arthritis gloves, Arthritis Hot, Bengay, Capzasin. Artificial Eye, Limb, Teeth Amount paid for the design and purchase of an artificial limb, eye or teeth is an eligible medical expense.Aspirin
The cost of an OTC aspirin is an eligible medical expense. Asthma Equipment and Treatment The cost of asthma equipment (e.g., a nebulizer or peak flow meter) is an eligible medical expense. Asthma Equipment and Treatment (over-the-counter products) The cost of an OTC asthma product is an eligible medical expense. OTC products include, but are not limited to: Bronkaid, Bronkolixir,Primatine.
Autoette (wheelchair) The cost of an autoette is an eligible medical expense. Automated External Defibrillator (AED) The cost of an automated external defibrillator is an eligible medicalexpense.
Automobile Modifications (specially designed car to hold awheelchair)
The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car.Back Brace
Both Rigid (Hard) and Soft (Elastic) Back Braces are eligible medicalexpenses.
Bandages, Band-Aids
The cost of bandages is an eligible medical expense. Bandages include, but are not limited to: Ace bandages, Band-Aid, Curad, Johnson & Johnson, Nexcare. Bariatric Surgery (for obesity treatment) The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of thesesurgeries.
Bedside Commode, Toilet (for medical reasons) The cost to purchase or rent a bedside commode or bedside toilet is an eligible medical expense. Birth Control (over-the-counter) The cost of an OTC birth control product is an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure,spermicides.
Birth Control (prescription) The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. Birthing Classes (related to childbirth) Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for thatportion.
Blood Pressure Monitor The cost of a blood pressure monitoring device is an eligible medicalexpense.
Blood Sugar Test Kits and Strips Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs.Body Scan
The cost of a body scan (e.g., an MRI, PET, CAT) is an eligiblemedical expense.
Bracanalysis Testing The cost of diagnostic testing for genetic mutations that may include DNA collection is an eligible medical expense.Braces, Orthodontia
The cost of orthodontia care (including braces and invisalign) is an eligible medical expense. Braille Books and Magazines For use by visually impaired persons, the cost of Braille books and magazines are eligible medical expense. Note: The eligible expense includes only the amount above the cost of the product in its standardform.
Breast Pump Purchase or Rental The cost to purchase or rent a breast pump is an eligible medicalexpense.
Breast Reconstruction Surgery The cost of breast reconstruction surgery following a mastectomy is an eligible medical expense. Breastfeeding Supplies Breastfeeding supplies are the equipment and disposable supplies that assist with breastfeeding or nursing. The cost of those supplies are eligible medical expenses. This includes but is not limited to: breast pumps, disposable bra pads, lanolin cream, breastfeeding tubes andcontainers.
Breathalyzer
The cost of both in-home and doctor's office alcohol testing areeligible expenses.
Bus Fare (primarily for medical care) The cost of bus fare primarily for and essential to medical care, is an eligible medical expense. Bus fare expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons. Car Modification (specially designed car to hold a wheelchair) The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car. Car Rental (primarily for medical care) The cost of a car rental primarily for and essential to medical care, is an eligible medical expense. Car rental expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons. Carpal Tunnel Wrist Supports, Braces The cost of carpal tunnel wrist supports is an eligible medicalexpense
Childbirth
Amounts paid to a physician or licensed midwife for child delivery are eligible medical expenses. Childbirth Classes/Lamaze (related to childbirth) Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for thatportion.
Chinese Herbal Practitioner Treatments provided by a Chinese Herbal Practitioner are eligible if treating a specific medical condition.Chiropody
Amounts paid to a chiropodist (a chiropractic foot doctor) is an eligible medical expense.Chiropractor
The cost of chiropractor services is an eligible medical expense.Cholesterol Testing
OTC portable blood test systems (such as Cardio Chek) and test strips are an eligible medical expense. Christian Science Practitioners Treatments provided by a Christian Science Practitioners are eligible if treating a specific medical condition.Circumcision
The cost of circumcision is an eligible medical expense.Clinic
The cost of medical treatment at a health clinic is an eligiblemedical expense.
COBRA Premiums (If you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. However, insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap.Co-Insurance
A coinsurance charge for medical care is an eligible medicalexpense.
Cold and Hot Packs (for medical purposes) When used for medical purposes, amounts paid for cold and hot packs are eligible medical expenses.Cold Medicines
The cost of an OTC cold medicine is an eligible medical expense. OTC products include, but are not limited to: Advil, Comtrex, Contac, Coricidin, Dayquil, Mucinex, Nyquil, Robitussin, Sudafed, TheraFlu,Triaminic, Vicks.
Cold Sore and Fever Blister Treatments (lip balm SPF 15 or higher) The cost of medicated lip balm with an SPF 15 or higher is an eligiblemedical expense.
Cold Sore and Fever Blister Treatments (over-the-counter) The cost of an OTC cold sore or fever blister product is an eligible medical expense. OTC products include, but are not limited to: AbrevaCream, Herpecin.
Companion Animal
The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses. Compression Socks, Stockings The cost of compression socks, also known as anti-embolism socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense.Condoms
The cost of condoms are an eligible medical expense. Contact Lenses and Supplies (for vision correction) If contact lenses are needed to correct vision, amounts paid for the purchase of contact lenses (including shipping and handling fees) are eligible medical expenses. Amounts paid for contact lens solution, cleaning or soaking solutions, lens storage cases, supplies and exams (including fittings) are also eligible expenses. Contact Lenses and Supplies (over-the-counter products) The cost of an OTC eye drop and re-wetting product is an eligible medical expense. OTC products include, but are not limited to: Visine, Opcon-A, Clear eyes. Continuous Positive Airway Pressure (CPAP) The cost of the breathing therapy known as CPAP is an eligible medicalexpense.
Contraceptives
The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides.Copayment (copay)
A medical copayment is an eligible medical expense. Note: The receipt must clearly state that the expense is a copayment for a healthcareservice.
Corneal Molding
Cost for orthokeratology (also known as corneal molding) is an eligible medical expense. It is a surgical procedure similar to Lasik Surgery to improve or correct near sightedness, far sightedness andastigmatism.
Corneal Ring Segments The cost of these devices implanted in the eye to correct vision is an eligible medical expense.Cough Suppressants
The cost of an OTC cough suppressant is an eligible medical expense. OTC products include, but are not limited to: cough syrup and coughdrops.
Counseling (for medical condition) The cost of counseling for a medical condition is an eligible medicalexpense.
Crown, dental
The cost of a crown is an eligible medical expense.Crutches
The purchase or rental of crutches is an eligible medical expense.Crystalens
Artificial lens implants used to treat cataracts is an eligible medical expense. The cost of the FDA approved procedure where the patient’s lens is removed and replaced with a clear plastic lens that allows him or her to focus more accurately is also an eligiblemedical expense.
Decongestant
The cost of an OTC decongestant is an eligible medical expense. OTC products include, but are not limited to: Contac-D, Dimetapp, Sudafed,Triaminic.
Deductibles
Deductibles are eligible medical expenses.Defibrillator
The cost of a defibrillator is an eligible medical expense. Dehydration Treatment The cost of an OTC dehydration product is an eligible medical expense. OTC products include, but are not limited to: Pedialyte. Dental Emergency Kit A dental emergency kit used for the temporary repair of loose caps or lost fillings is an eligible medical expense. Dental Maintenance Organization (DMO) Fees (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Dental Treatment (non-cosmetic) Amounts paid for dental treatment (X-rays, fillings, extractions, dentures (artificial teeth), caps, crowns, fluoride treatments, implants, non-cosmetic veneers etc.) and orthodontia (including braces and Invisalign) are eligible medical expenses. Dental Treatment (over-the-counter flouride) The cost of an OTC fluoride product is an eligible medical expense.Denture Adhesive
The cost for a product to secure dentures in the mouth is an eligible medical expense. Examples include, but are not limited to: Fixodent, Polident, Effergrip and Sea-Bond.Denture Cleanser
The cost for a product to clean dentures is an eligible medicalexpense.
Dentures (non-cosmetic) Non-cosmetic dentures are an eligible medical expense.Denturist
Amounts paid to a denturist for the treatment of a dental condition are eligible medical expenses. (A denturist is a dental technician specializing in making and fitting dentures as a direct service to the public rather than through a licensed dentist.) Dermatology (for medical condition) Amounts paid to a dermatologist for a medical condition (such as acne or psoriasis) are eligible medical expenses. Diabetic Equipment and Supplies Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs. Diagnostic Tests and Procedures Amounts paid for diagnostic services are eligible medical expenses.Diaper Rash Creams
The cost of an OTC diaper rash product is an eligible medical expense. OTC products include, but are not limited to: Aquaphor, Balmex,Desitin.
Diarrhea Medicine
The cost of an OTC anti-diarrhea product is an eligible medical expense. OTC products include, but are not limited to: Pepto Bismol, Imodium AD, Kaopectate.Diathermy
The cost of diathermy used to destroy abnormal cells or as a form of physical therapy is an eligible medical expense. Digestive Aids (over-the-counter) The cost of over-the-counter digestive aids is an eligible medical expense. This includes but is not limited to: acid controllers, laxatives, anti-diarrheals, and anti-gas medicine.Doctor Fees
The cost of doctor fees are an eligible medical expense. Drug Addiction Treatment The cost of treatment at a center for alcohol or drug addiction is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment. Drug Overdose Treatment The cost of treatment for a drug overdose is an eligible medicalexpense.
Drugs (over-the-counter) The cost of an OTC product, drug or medicine is an eligible medicalexpense.
Drugs (prescription) The cost of a prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees. Durable Medical Equipment (DME) The cost to purchase or rent durable medical equipment is an eligible medical expense. DME includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet. Ear Care and Ear Wax Removal Products The cost of an OTC ear care product is an eligible medical expense. OTC products include, but are not limited to: Debrox, Murine.Ear Plugs
The cost of ear plugs is an eligible expense.Epsom Salts
Eligible when used as a Soaking Aid for sprains and bruises. Erectile Dysfunction Treatment The cost for the treatment of erectile dysfunction is an eligible medical expense. This includes but not limited to prescribed medications: Viagra, Cialis, Levitra.Expectorant
The cost of an OTC expectorant is an eligible medical expense. OTC products include, but are not limited to: Broncolin, Mucinex, TheraFlu, Tussin EX.Experimental Drugs
The cost of prescription and legally-obtained experimental drugs for medical care is an eligible medical expense Experimental Medical Services When administered by a health care professional to treat a medical condition, the cost of experimental medical services are an eligiblemedical expense.
Eye Care (for eye drops) The cost of an OTC eye drop is an eligible medical expense. OTC products include, but are not limited to: Visine, Wetting drops. Eye Exams, Eyeglasses, Eye Surgery, Eye Care The cost of prescription eyeglasses, prescription sunglasses, eye exams, eye patches, reading glasses, OTC reading glasses, tinting of prescription eyewear, prescription goggles and prescription safety glasses are eligible medical expenses. This also includes but not limited to: cataract surgery, Lasik surgery, Corneal Rings. Eye Exams, Eyeglasses, Eye Surgery, Eye Care (for repairs) Repairs associated with the repair of Eyeglasses, Prescription Sunglasses, Reading Glasses and Prescription Goggles/Safety Glasses are eligible medical expenses. Feminine Hygiene Products The cost of feminine hygiene products are eligible medical expenses. This includes, but is not limited to: sanitary napkins, pads, liners, tampons, cups, sponges. Fertility Enhancement and Treatments (ovulation kit) The cost of an ovulation kit is an eligible medical expense. Fever Reducing Medication The cost of an OTC fever reducing medicine is an eligible medical expense. OTC products include, but are not limited to: Aspirin, FeverAll, Ibuprofen, Motrin, Tylenol. First Aid Drugs and Medicines The cost of an OTC first aid medicines is an eligible medical expense. OTC products include, but are not limited to: Anti-Bacterial Sprays, Antiseptics, Peroxide, Rubbing Alcohol, Witch Hazel.First Aid Kit
The cost of a first aid kit is an eligible medical expense.First Aid Supplies
The cost of first aid supplies is an eligible medical expense. First aid supplies include, but are not limited to: bandages, wraps, adhesives, cold or hot packs, gauze, joint supporters, splints, tape,thermometer.
Flavoring Added to Medication The cost of adding flavoring to medication is an eligible medicalexpense.
Flu Shot
The cost of a flu shot is an eligible medical expense. Fluoride product (over-the-counter) The cost of an OTC fluoride product is an eligible medical expense. Foot Care (non-medicated) The cost of non-medicated foot care products is an eligible medical expense. Non-medicated foot care include, but are not limited to: callous removers, bunion treatments, non-medicated blister care products. The cost of custom made and over the counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense. Foot Care (over-the-counter) The cost of an OTC foot care product is an eligible medical expense. OTC products include, but are not limited to: medicated blister care, medicated callous removers, corn & callous treatments. Fuel, Gasoline for Medical Care The cost of fuel/gas primarily for and essential to medical care, is an eligible medical expense. Fuel/gas expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2020, the eligible rate is $0.17 per mile (effective 1/1/2020). For 2019, the eligible rate is $.20 per mile (effective 1/1/2019). Note: Long-distance travel cannot be for purelypersonal reasons.
Gastric Bypass Surgery Including Excess Skin Removal (for obesitytreatment)
The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of thesesurgeries.
Gauze Pads
Gauze pads are an eligible medical expense.Genetic Testing
The cost of genetic testing to identify the potential for, or existence of, a medical condition (such as a test for the breast cancer gene) is an eligible medical expense. However, the cost of a DNA test to determine paternity is not an eligible medical expense. Glucosamine and Glucosamine Chondroitin The cost of Glucosamine and Glucosamine Chondroitin is an eligiblemedical expense.
Glucose Monitoring Device Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs.Glucose Tabs
Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs. Goggles (prescription) The cost of prescription eyeglasses, prescription sunglasses, eye exams, eye patches, reading glasses, OTC reading glasses, tinting of prescription eyewear, prescription goggles and prescription safety glasses are eligible medical expenses. This also includes but not limited to: cataract surgery, Lasik surgery, Corneal Rings.Guide Dog
The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses.Gynecologist
The cost of gynecological care is an eligible medical expense. Handicap, Disability Placards and License Plates The cost of handicap license plates/placards is an eligible medicalexpense.
Headache Medicine
The cost of an OTC headache medicine is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Anacin, Aspirin, Doan’s, Excedrin, HeadOn, IMAK, Motrin, Tylenol.Health Screenings
The cost of health screenings/preventive care screenings is an eligible medical expense. Preventive care includes but is not limited to: blood pressure, glaucoma, cataracts, hearing, cholesterol, life line screenings. The cost of a body scan (e.g., an MRI,PET,CAT) and amounts paid for diagnostic services are also eligible medicalexpenses.
Hearing Aids and Batteries Amounts paid for a hearing aid and hearing aid batteries are eligible medical expenses. This also includes a hearing aid remote control (to adjust the volume) and a dehumidifier or sanitizer for the hearing aid. Repairs for the hearing aid are also eligible medical expenses.Heart Rate Monitors
Cost of a heart rate monitor is an eligible medical expense.Heating Pads
When used for medical purposes, the cost of a heating pad, hot pack or cold pack is an eligible medical expense. Hemorrhoid Treatment The cost of an OTC hemorrhoid treatment is an eligible medical expense. OTC products include, but are not limited to: Fleet, Preparation H, Tronolane, Tucks. Home Diagnostic Kits, Tests, Devices The cost of a home diagnostic kit, test or device is an eligible medical expense. Examples include, but are not limited to: blood pressure monitors, cholesterol tests, colorectal screenings, diabetic equipment and supplies, pregnancy tests.Home Health Care
Wages and other amounts paid for nursing services associated with caring for the participant, spouse or tax-qualified dependent’s medical condition (dispensing medications, changing dressings, attention and care to wounds, monitor vital signs, record and document assessment results, bathing and grooming the patient, etc.) are eligible medical expenses. Note: Only amounts paid for nursing services are eligible medical expenses. If the attendant also provides personal and household services, these amounts must be divided between the time spent performing household/personal services and the time spent for nursing services. Hospice Care/Palliative Care Amounts paid for hospice care or palliative care is an eligiblemedical expense
Hospital Services
Amounts paid for hospital services are eligible medical expenses. Amounts paid for ancillary hospital services (such as an upgrade from a semi-private to private room or fees charged for parents to stay with a child) are eligible medical expenses.Human Guide
To assist a physically, visually, hearing or mentally impaired person, fees paid for a human guide are eligible medical expenses. Humidifier (for medical care) The cost of a vaporizer or humidifier for medical care is an eligiblemedical expense.
Immunizations
The cost of a vaccination and immunization is an eligible medical expense. This includes, but is not limited to: an immunization required for travel, Gardasil and HPV vaccinations. Incontinence Products The cost of an incontinence product is an eligible medical expense. Examples include, but are not limited to: Depend, Invacare, Poise,Prevail, Serenity.
Insect Bite Cream, Ointment The cost of an OTC insect bite treatment is an eligible medical expense. OTC products include, but are not limited to: After Bite, Benadryl, Calamine lotion, Cortaid, Cortizone, Lanacane, Mitigator.Insulin
The cost of insulin is an eligible medical expense. Insurance Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Investigational Surgery The cost of investigational surgery is an eligible medical expense. Invisalign Orthodontics The cost of orthodontia care (including braces and invisalign) is an eligible medical expense.Kenesio Tape
The cost of kenesio tape is an eligible medical expense since it allows the body and muscles to move while assisting in rehabilitation.Laboratory Fees
Laboratory fees are eligible medical expenses. Lactation Aids and Supplies The cost of lactation aids (e.g., breast milk transport bag, freezing/storage packs, nursing/pumping bra, nursing pads) are eligible medical expenses. Lactation Consultant When needed for a woman experiencing lactation problems (such as being unable to breast feed,) the cost of a lactation consultant is an eligible medical expense Lamaze Classes (related to childbirth) Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for thatportion.
Lap Band Surgery (for obesity treatment) The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of thesesurgeries.
LASIK, Laser Eye Surgery The cost of LASIK/PRK or radial keratotomy surgery is an eligiblemedical expense.
Laxatives
The cost of an OTC laxative is an eligible medical expense. OTC products include, but are not limited to: Correctol, Dulcolax, Ex-lax, Milk of Magnesia, Senokot. Legal Fees (for fertility treatment) Legal fees in connection with fertility treatments for you, your spouse or dependent, if preparatory to the procedure are eligiblemedical expenses.
Legal Fees (to authorize treatment) To authorize treatment for a mentally ill patient, legal fees are eligible medical expenses. Lice Treatment and Removal (fees paid to specialist) Fees paid for a lice removal services performed by a lice treatment specialist in your home are eligible medical expenses. Lice Treatment and Removal (over-the-counter) The cost of an OTC lice treatment is an eligible medical expense. OTC products include, but are not limited to: Nex, Rid. Life Alert Emergency Medical Alert System The cost of a life alert emergency medical alert system is an eligiblemedical expense.
Lip Balm (SPF 15 or higher) The cost of lip balm (regular/standard or medicated) with an SPF 15 or higher is an eligible medical expense. Liquid Adhesive Bandage for Small Cuts Liquid adhesive bandage for small cuts is an eligible medical expense. Lodging and Trips (to receive medical care) When the main reason for being in a hospital or other institution is to receive medical care, the cost of lodging, including meals, provided by the hospital are eligible medical expenses. Note: While you're away from home and receiving medical care, you may include lodging costs for the patient and a necessary traveling companion (e.g., parent with sick child or travel to be with a sick spouse), up to $50 per person, per night for lodging (maximum $100 per night). However, the lodging must be primarily for and essential to medical care; the medical care must be provided by a doctor in a licensed hospital or medical care facility related to, or the equivalent of, a licensed hospital; the lodging cannot be lavish or extravagant under the circumstances. There shouldn't be a significant element of personal pleasure, recreation or vacation in the travel away fromhome.
Long Term Care Insurance Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Long Term Care Services The cost of the medical portion only of care in a long term care facility is an eligible medical expense. Long Term Disability (LTD) Insurance Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Mastectomy-Related Expenses Each of the following mastectomy-related expenses is an eligible medical expense: 1) the cost of a breast prosthesis; 2) the cost of a bra or other clothing (such as a sports bra or bathing suit) designed to hold the breast prosthesis. Note: the eligible expense includes only the amount above the cost of the product in its standard form; 3) the cost of a special bra or other clothing with built in breastprosthesis.
Maternity Aids
Cost of certain maternity items is an eligible medial expense. Eligible items include, but are not limited to: products that reduce discomfort associated with pregnancy such as maternity girdle and maternity support belts.Maternity Charges
Amounts paid to a physician or licensed midwife for delivery charges are eligible medical expenses. Meals (for inpatient care) Amounts paid for meals associated with inpatient medical care is an eligible medical expense. Medical Alert Bracelet, Necklace The cost of alert jewelry and membership fees associated with the jewelry are eligible expenses. Medical Care Outside U.S. The cost of legal medical care received outside the U.S. is an eligible medical expense. Note: The medical care must be legal in the foreign country and in the U.S. (had it been provided here). Medical Information Storage Plan The cost to store medical information in and to be able to retrieve that information from a computer data bank, is an eligible medicalexpense.
Medical Monitoring, Testing Devices The cost of a medical monitoring or testing device (e.g., to test blood pressure, blood sugar, cholesterol, heart, etc.) is an eligiblemedical expense.
Medical Records
The cost of transferring or copying medical records is an eligiblemedical expense.
Medical Services (payment for treatment of medical condition) Amounts paid to physicians, surgeons, specialists and other medical practitioners for treatment of medical conditions are eligible medicalexpenses.
Medical Services (phone consultation) The cost of a phone consultation with a Medical provider is an eligible medical expense. This includes TelaDoc services. Medical Services (virtual office visits) The cost of virtual office visits is an eligible medical expense, since they are doctor-patient interactions that may occur via email or through a Web-based portal. They offer patients an alternative way to communicate with their physician regarding health issues that do not require face-to-face contact such as routine follow-ups. These expenses are eligible on a per visit basis. Medicare Parts A, B and D (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Medicated Lip Product (for cold sore/fever blister) The cost of an OTC cold sore or fever blister product is an eligible medical expense. OTC products include, but are not limited to: AbrevaCream, Herpecin.
Medicated Lip Product (lip balm SPF 15 or higher) The cost of medicated lip balm with an SPF 15 or higher is an eligiblemedical expense.
Medicine and Drugs from Other Countries (purchased and consumed inanother country)
The cost of prescription medicine purchased and consumed in another country (such as while on vacation or living as an expatriate) is an eligible medical expense, if the drug is legal in both the other country and the U.S. Medicine and Drugs, Over-the-Counter (OTC) The cost of an OTC product, drug or medicine is an eligible medicalexpense.
Medicine, Prescription The cost of a prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees.Mediscope
The cost of a medical device used to provide bright illumination during an examination of ears, nose and throat is an eligible medicalexpense.
Menstrual Pain Reliever The cost of an OTC menstrual pain reliever is an eligible medical expense. OTC products include, but are not limited to: Diurex, Midol,Motrin, Pamprin.
Mentally Challenged, Special Home The cost of a special home (not the home of a relative) to make the transition from a mental hospital to community living is an eligiblemedical expense.
Midwife
Amounts paid for a midwife are eligible medical expenses. Migraine Relief (over-the-counter) The cost of an OTC pain relievers is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Aspirin, BenGay, Capzasin, Castiva, Motrin, Tylenol, Zostrix. Mileage (primarily for medical care) The cost of mileage primarily for and essential to medical care, is an eligible medical expense. Mileage fees are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2020, the eligible rate is $0.17 per mile (effective 1/1/2020). For 2019, the eligible rate is $.20 per mile (effective 1/1/2019). Note: Long-distance travel cannot be for purely personal reasons.Monitor
The cost of a medical monitoring or testing device (e.g., to test blood pressure, blood sugar, cholesterol, heart, etc.) is an eligiblemedical expense.
Morning-After Contraception Pill The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides.Motion Sickness
The cost of an OTC motion sickness product is an eligible medical expense. OTC products include, but are not limited to: Bonine, Dramamine, Emetrol, Meclizine.Mouth Guard
The cost of a Mouth Guard is an eligible medical expense. This is true for prescription and OTC.Nasal Aspirator
The cost of a nasal aspirator is an eligible medical expense. OTC products include, but are not limited to: NoseFrida Nasal Sprays, Nasal Solutions The cost of an OTC nasal spray or solution is an eligible medical expense. OTC products include, but are not limited to: 4-Way, Afrin, Ayr, ENTSOL, Nasal Crom, Neo-Synephrine, Nostrilla, Simply Saline,Vicks.
Nasal Strips
The cost of Nasal Strips to alleviate snoring or reduce nasal congestion is a qualified medical expense. OTC products include, but are no limited to: Breathe Clear, Breathe Right, nose cones, Snorezz. Natural Lens Replacement The cost of this FDA approved procedure where the patient’s lens is removed and replaced with a clear plastic lens that allows him or her to focus more accurately is an eligible medical expense. Naturopathic Healers Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition.Nebulizer
The cost of a nebulizer or peak flow meter is an eligible medicalexpense.
Neti Pot
The cost of a neti pot used for sinus and allergy relief is an eligible medical expense.Neurologist
The cost of neurological care is an eligible medical expense. Nicotine Gum and Patches The cost of an OTC nicotine gum and patch is an eligible medical expense. OTC products include, but are not limited to: nicotine gumand patches.
Non-Prescription Drugs, Medicines The cost of an over-the-counter (OTC) product, drug or medicine is an eligible medical expense. Norplant insertion or removal The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. NSAIDS (over-the-counter) The cost of an OTC pain reliever is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Aspirin, BenGay, Capzasin, Castiva, Motrin, Tylenol, Zostrix. Nursing services provided at home Wages and other amounts paid for nursing services associated with caring for the participant, spouse or tax-qualified dependent’s medical condition (dispensing medications, changing dressings, attention and care to wounds, monitor vital signs, record and document assessment results, bathing and grooming the patient, etc.) are eligible medical expenses. Note: Only amounts paid for nursing services are eligible medical expenses. If the attendant also provides personal and household services, these amounts must be divided between the time spent performing household/personal services and the time spent for nursing services.Nursing Supplies
Nursing supplies are the equipment and disposable supplies that assist with breastfeeding or nursing. The cost of those supplies are eligible medical expenses. This includes but is not limited to: breast pumps, disposable bra pads, lanolin cream, breastfeeding tubes andcontainers.
Obstetrical Care
The cost of obstetrical care is an eligible medical expense. Documentation requires an Explanation of Benefits (EOB) or itemized statement of the birth expenses. Note: Copay amounts and tests performed during the pregnancy (i.e., ultrasound) would be considered eligible when the expense is incurred, if billed separately.Occlusal Guard
The cost of a occlusal or mouth guard is an eligible medical expense. This is true for prescription and over-the-counter. Occupational Therapy The cost of occupational therapy is an eligible medical expense.Oncologist
Fees paid to an oncologist are eligible medical expenses. Operation (for medical care) The cost of a legal operation required for medical care performed legally in the U.S. or performed legally in another country (and which would be legal if performed in the U.S.) is an eligible medicalexpense.
Ophthalmologist
Amounts paid to an ophthalmologist are eligible medical expenses.Optometrist
Amounts paid to an optometrist are eligible medical expenses. Organ Donor Expenses (paid by donor) Expenses for services received by the donor are eligible medical expenses, if paid by the donor. Organ Donor/Recipient Expenses (paid by recipient) The expenses related to the recipient or donor are eligible as long as the recipient is responsible for the services received and is covered by a health care FSA, HSA or HRA.Orthodontia
The cost of orthodontia care (including braces and invisalign) is an eligible medical expense.Orthokeratology
Cost for orthokeratology (also known as corneal molding) is an eligible medical expense. It is a surgical procedure similar to Lasik Surgery to improve or correct near sightedness, far sightedness andastigmatism.
Orthotics
The cost of custom made and over-the-counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense. OSHA Handling Fees for Bio-Hazards Waste Disposal. Fees paid for Bio-Hazard Waste Disposal for the Safe disposal of Potential Blood Borne Pathogen, Sharps and Related Bio-Hazardous Waste are eligible medical expenses. Some doctors and dentists may itemize these on their invoices.Osteopath
The cost of osteopathic care is an eligible medical expense. Ostomy, Colostomy Supplies Amounts paid for items such as pouches, lubricants, deodorants, support garments, etc. are eligible medical expenses. OTC (over-the-counter) The cost of an OTC product, drug or medicine is an eligible medicalexpense.
Out-of-Network Provider Costs incurred by the member for expenses not covered by insurance and charged for using an out of network provider are eligible medicalexpenses.
Over-the-Counter (OTC) Drugs and Medicines The cost of an OTC product, drug or medicine is an eligible medicalexpense.
Over-the-Counter (OTC) Supplies Amounts paid for OTC supplies are eligible expenses. This includes but is not limited to: crutches, band-aids, and braces.Ovulation Monitor
The cost of an ovulation monitor is an eligible medical expense.Oxygen
Amounts paid, including rental fees, for oxygen and oxygen equipment are eligible medical expenses. Pain Relievers (Over-the-counter) The cost of an OTC pain relievers is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Aspirin, BenGay, Capzasin, Castiva, Motrin, Tylenol, Zostrix. Parking Fees (primarily for medical care) The cost of parking fees primarily for and essential to medical care, is an eligible medical expense. Parking fees are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Particulate Respirator Mask The cost of a surgical mask is an eligible medical expense. Patterning Exercises Costs to hire an individual to perform patterning exercises are qualified medical expenses.Peak Flow Meter
The cost of a nebulizer or peak flow meter is an eligible medicalexpense.
Pediculicide/Lice Treatment The cost of an OTC lice treatment is an eligible medical expense. OTC products include, but are not limited to: Nex, Rid. Fees paid for a lice removal services performed by a lice treatment specialist in your home are also eligible medical expenses.PET Scan
Cost for a PET scan which is a nuclear medicine imaging technique is an eligible medical expense.Petroleum Jelly
The cost of an OTC petroleum jelly product is an eligible medical expense. Petroleum jelly protects minor cuts, burns, skin protectant,heals skin.
Phone Consultation with Doctor The cost of a phone consultation with a Medical provider is an eligible medical expense. This includes TelaDoc services.Physical exam
The cost of a physical exam is an eligible medical expense. Note: Work-related physical exams are eligible UNLESS the examination is paid by the employer.Physical Therapy
The cost of physical therapy is an eligible medical expense. Pill Cutters, Pill Box, Pill Sorters and Pill Organizers The cost of a pill cutter or accessories is an eligible medicalexpense.
Post Mastectomy Clothing Each of the following mastectomy-related expenses is an eligible medical expense: 1) the cost of a breast prosthesis; 2) the cost of a bra or other clothing (such as a sports bra or bathing suit) designed to hold the breast prosthesis. Note: the eligible expense includes only the amount above the cost of the product in its standard form; 3) the cost of a special bra of other clothing with built in breastprosthesis.
Pre-Existing Condition Medical costs not covered by the medical plan due to the plan’s limitation on pre-existing conditions is an eligible medicalexpenses.
Pregnancy and Delivery Charges The cost of obstetrical care is an eligible medical expense. Documentation requires an Explanation of Benefits (EOB) or itemized statement of the birth expenses. Note: Copay amounts and tests performed during the pregnancy (i.e., ultrasound) would be considered eligible when the expense is incurred, if billed separately. Prepaid expenses for the birth are not eligible until the baby is born and insurance has paid. The incurred date is considered the date of birth to avoid overpayment situations and crossing of plan years. Pregnancy Charges Paid Monthly per Contract Pregnancy charges paid monthly per contract are considered eligible when baby is born and after insurance pays. Documentation requires an Explanation of Benefits (EOB) or itemized statement of the birthexpenses.
Pregnancy Items
Cost of certain pregnancy items is an eligible medial expense. Eligible items include, but are not limited to: products that reduce discomfort associated with pregnancy such as maternity girdle and maternity support belts. Pregnancy Termination The cost of a legal abortion is an eligible medical expense.Pregnancy Tests
The cost of a pregnancy test is an eligible medical expense. Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D.Prenatal Vitamins
The cost of Prenatal vitamins is an eligible medical expense. Prescription Drugs, Medicines The cost of a medicine/prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees. The drug must be legal in the country where you purchased and used it. Preventative Care Screenings The cost of preventive care screenings is an eligible medical expense. Preventive care includes but is not limited to: blood pressure, glaucoma, cataracts, hearing, cholesterol, life line screenings. Preventive Care Services The cost of preventive care is an eligible medical expense. Preventive care includes but is not limited to: Periodic health evaluations, including tests and diagnostic procedures in connection with routine examinations (e.g., annual physicals), routine prenatal and well-child care, child and adult immunizations, certain screening services. Private Hospital Room The extra cost for a private hospital room is an eligible medicalexpense.
Prosthesis
Amount paid for the design and purchase of an artificial limb, eye or teeth is an eligible medical expense. Psychiatric Services and Care The cost of psychiatric care, including care in a specially equipped center for receiving medical care, is an eligible medical expense.Psychoanalysis
Fees paid for Psychoanalysis are eligible medical expenses.Psychologist
Fees paid for Psychologist are eligible medical expenses.Psychotherapist
Fees paid for Psychotherapy are eligible medical expenses.Psychotherapy
Fees paid for Psychotherapy are eligible medical expenses; this would include Individual and Family Psychotherapy.Pulse Oximeter
The cost of a pulse oximeter which checks oxygen levels and pulse rates is an eligible medical expense.Radial Keratotomy
The cost of radial keratotomy is an eligible medical expense.Reading Glasses
The cost of reading glasses is an eligible medical expense. Reasonable & Customary (R&C) Amounts that exceed R&C are eligible medical expenses.Respite Care
Amounts paid for respite care is an eligible medical expense Safety Glasses (Prescription) The cost of prescription safety glasses is an eligible medicalexpense.
Sales Tax
Sales tax incurred for a medical service or product (including OTC) are eligible medical expenses.Screening Tests
The cost of screening tests is an eligible medical expense. These are considered preventive care and routine medical tests that can help detect diseases and medical conditions. It includes but is not limited to: blood pressure tests, cholesterol tests, colorectal cancer screening, diabetes tests, HIV tests, syphilis tests, bone mineral density tests, mammograms, cervical cancer screenings, and prostatecancer screenings.
Seeing-eye Dog, Service Animal The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses. Services Not Covered by Insurance The cost of medical, dental and vision procedures and items that are not covered under any health plan you may have but are to treat a medical condition is an eligible medical expense.Sharps Container
The cost of a containers used for the disposal of needles is an eligible medical expense. Shipping and Handling Shipping and handling fees associated with medical care (for contact lenses, mail-order drugs, etc.) are eligible medical expenses.Sinus Medication
The cost of an OTC sinus medication is an eligible medical expense. OTC products include, but are not limited to: Advil, Alavert, Aleve, Benadryl, Chlor-Trimeton, Claritin, Excedrin, Mucinex, Sudafed,Tavist, Tylenol.
Sitz Bath
The cost of a sitz bath is an eligible medical expense. A sitz bath is one in which the person sits in water up to the hips. It promotes healing and symptom relief for conditions such as for hemorrhoids, rectal surgery and recent childbirth. Sleep Deprivation Treatment The cost of an OTC sleeping deprivation treatment is an eligible medical expense. OTC products include, but are not limited to: Nytol,Sominex, Unisom.
Smoking Cessation Program and Medication The cost of a smoking cessation program is an eligible medicalexpense.
Smoking Cessation Program and Medication (over-the-counter) The cost of an OTC smoking cessation medication is an eligible medical expense. OTC products include, but are not limited to: Commit, Endit, Habitrol, NicoDerm, Nicorette, Smoke Away.Somnoplasty
The cost of somnoplasy is an eligible medical expense. Somnoplasty uses radio frequency to treat sleep apnea, chronic nasal obstruction, or habitual snoring that is a result of obstructed airways is an eligible medical expense. Specialized Medical Equipment or Services The cost to purchase or rent specialized medical equipment or services/durable medical equipment is an eligible medical expense. This includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet.Speech Therapy
Amount paid for Speech Therapy is an eligible medical expense.Spermicide
The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides. Sterilization Procedure or Reversal The cost to obtain or reverse a sterilization is an eligible medicalexpense.
Stop-Smoking Program The cost of a smoking cessation or stop-smoking program is an eligiblemedical expense.
Student Health Fee (cost of medical care) The cost of medical care is an eligible medical expense. Substance Abuse Treatment The cost of treatment at a center for substance abuse is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment. Subway Fare (primarily for medical care) The cost of subway fare primarily for and essential to medical care, is an eligible medical expense. Subway fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Sunburn Cream, Ointment The cost of an OTC sunburn cream is an eligible medical expense. OTC products include, but are not limited to: Solarcaine, Water Jel. Sunglasses (with prescription) The cost of prescription sunglasses is an eligible medical expense. Sunscreen (SPF 15 or higher) The cost of an over-the-counter sunscreen product with SPF 15 or higher is an eligible medical expense.Support Hose
The cost of support hose, also known as anti-embolism socks, compression socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense.Suppositories
The cost of an over-the-counter (OTC) laxative/suppository is an eligible medical expense. OTC products include, but are not limited to: Correctol, Dulcolax, Ex-lax, Milk of Magnesia, Senokot. Surgery (for medical care) The cost of a legal surgery/operation required for medical care performed legally in the U.S. or performed legally in another country (and which would be legal if performed in the U.S.) is an eligiblemedical expense.
Surrogate Mother Fees (for medical expenses, if member is surrogate) If the plan participant is fulfilling the role of a surrogate mother, medical expenses not paid by insurance or the adoptive parents are eligible medical expenses. Taxes on Medical Services and Products Taxes (such as sales tax or a hospital bill surcharge) incurred for a medical service or product, including OTC, are eligible medicalexpenses.
Taxi Fare (primarily for medical care) The cost of taxi fare primarily for and essential to medical care, is an eligible medical expense. Taxi fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Teething, Toothache Remedies The cost of an OTC toothache remedies is an eligible medical expense. OTC products include, but are not limited to: Anbesol, Orajel. Telephone Consultation Fee A fee charged by a health care professional for a telephone consultation is an eligible medical expense. Note: The associated phone charge (e.g., a toll call charge) is also an eligible medicalexpense.
Telephone for Hearing Impaired (fees for enhancing/repairing a phone) Fees associated with enhancing a telephone to accommodate a hearing-impaired person or person with a disability are eligible medical expenses. Note: Repair fees that exceed the cost of a regular telephone is also an eligible medical expense. Television for Visually or Hearing Impaired (cost to modify TV or buynew)
To assist a visually or hearing-impaired person, the cost to modify a television (such as an adapter for a regular television) or purchase a specially equipped television is an eligible medical expense. Note: Only the amount that exceeds the cost of a regular television is an eligible medical expense. Temporary Continuation of Coverage (TCC) Premiums (if you have anHSA)
Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Therapy (for medical condition) The cost of therapy for a medical condition or physical therapy is an eligible medical expense. Thermacare Heat Wraps Amounts paid for thermacare heat wraps are eligible medical expenses.Thermography
The cost for a thermography procedure is an eligible medical expense. Thermography is a painless non-invasive scan without radiation that allows the examiner to visualize and quantify changes in skin surface temperature. This is an alternative to a breast mammogram withradiation.
Thermometer
The cost of a thermometer for medical use (e.g., to take someone’s temperature) is an eligible medical expense.Throat Lozenges
The cost of OTC throat lozenges is an eligible medical expense. OTC products include, but are not limited to: Cepacol, Chloraseptic, Cold-Eeze, Halls, Sucrets, Vicks. Toll Fees (primarily for medical care) Toll fees primarily for and essential to medical care, is an eligible medical expense. Toll fees are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Topical Analgesics (Muscles and Arthritis) The cost of an OTC topical analgesic is an eligible medical expense. OTC products include, but are not limited to: Absorbine Jr., Aleve, Aspercreme, Tylenol Arthritis, Capzasin, Ultra Blue, Zostrix.Topical Steroids
The cost of an OTC topical steroid is an eligible medical expense. OTC products include, but are not limited to: topical gels, lotions and creams that contain hydrocortisone. Train Fare (primarily for medical care) The cost of train fare primarily for and essential to medical care, is an eligible medical expense. Train fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement.Transplant
An organ transplant is an eligible medical expense. This includes the donor's expenses if the donor is covered by the health care FSA, HSAor HRA.
Transportation (for medical care) The cost of transportation primarily for and essential to medical care, is an eligible medical expense. Transportation expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Eligible expenses include but are not limited to: ambulance services, bus, parking fee, plane fare, taxi, or toll. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2020, the eligible rate is $0.17 per mile (effective 1/1/2020). For 2019, the eligible rate is $.20 per mile (effective 1/1/2019). Note: Long-distance travel cannot be for purely personal reasons. Tri-Care Premiums (if you have an HSA) Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Trips (to receive medical care) When the main reason for being in a hospital or other institution is to receive medical care, the cost of lodging, including meals, provided by the hospital are eligible medical expenses. Note: While you're away from home and receiving medical care, you may include lodging costs for the patient and a necessary traveling companion (e.g., parent with sick child or travel to be with a sick spouse), up to $50 per person, per night for lodging (maximum $100 per night). However, the lodging must be primarily for and essential to medical care; the medical care must be provided by a doctor in a licensed hospital or medical care facility related to, or the equivalent of, a licensed hospital; the lodging cannot be lavish or extravagant under the circumstances. There shouldn't be a significant element of personal pleasure, recreation or vacation in the travel away fromhome.
Tubal Ligation, Tubal Ligation Reversal The cost of a tubal ligation or tubal ligation reversal is an eligiblemedical expense.
Ultrasound
The cost of an ultrasound for medical care (including prenatal care) is an eligible medical expense. Ultrasound, Pre-Natal (to monitor growth/condition) The cost of an ultrasound ordered by a health care professional to monitor the growth and condition of the fetus is an eligible medical expense, even if the benefit plan does not provide reimbursement.Urinalysis
The cost of urinalysis for medical conditions, including but not limited to, court ordered drug and alcohol testing both in-home and doctor's office, is an eligible medical expense. Usual, Customary and Reasonable (UCR), Charges Above Amounts that exceed reasonable and customary charges are eligiblemedical expenses.
Vaccinations
The cost of a vaccination and immunization is an eligible medical expense. This includes, but is not limited to: an immunization required for travel, Gardasil and HPV vaccinations. Vaporizer, Humidifier The cost of a vaporizer or humidifier for medical care is an eligiblemedical expense.
Vasectomy, Vasectomy Reversal The cost of a vasectomy or vasectomy reversal is an eligible medicalexpense.
Veneers (non-cosmetic) The cost of non-cosmetic veneers is eligible medical expense. Veterinary Fees (for guide dog/animal) Amounts paid for the care of a specially trained animal are eligiblemedical expenses.
Vision Correction
The cost of LASIK, laser eye surgery and radial keratotomy surgery is an eligible medical expense.Walker
The cost of an autoette, wheelchair, electronic wheelchair or walker (including the cost of maintenance) is an eligible medical expense. Wart Removal Treatment The cost of an OTC wart removal treatment is an eligible medical expense. OTC products include, but are not limited to: Dr. Scholl’s,Compound W.
Weight Loss Drugs, Medicines (prescribed) The cost for a weight-loss prescription is an eligible medicalexpense.
Well Baby, Well Child Care The cost of preventative and wellness checks is an eligible medicalexpense.
Wellness Scan
A wellness scan is an eligible medical expense. This is generally used to find signs of medical problems.Wheelchair, Walker
The cost of an autoette, wheelchair, electronic wheelchair or walker (including the cost of maintenance) is an eligible medical expense. Work Related Physical Examination for the Employee Work related physical exams are eligible UNLESS the examination is paid by the employer.X-Ray
The cost of X-ray fees for medical care is an eligible medicalexpense.
Yeast Infection Medication The cost of an OTC yeast infection medicine is an eligible medical expense. OTC products include, but are not limited to: Monistat,Vagistat.
Required
Abdominoplasty (for medical condition) A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Acupressure
A health care professional must provide evidence of medical necessity for the cost of acupressure to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursesment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical conditiont. Air Conditioner, Air Filter, Air Purifier A health care professional must provide evidence of medical necessity for the cost of a portable or permanent unit to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the Air Conditioner, Air Filter, Air Purifier is a permanent improvement that increases the value of the property, the excess value is not reimbursable. Also see Publication 502 at www.irs.gov for more information, including a worksheet. Allergy Treatment Products (required for medical condition) A health care professional must provide evidence of medical necessity for the cost of allergy treatment products to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical conditiont. Note: The reimbursable expense includes only the amount above the cost of the product in its standardform.
Alopecia Treatment
Alopecia is a medical condition resulting in the loss of hair from the body or head that can lead to baldness. A health care professional must provide evidence of medical necessity for the cost of alopecia treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement that specifically identifies that the recommendation and expense is for treatment of the medical condition. Alternative Medicine, Alternative Healers (for medical condition) Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include evidence of medical necessity (i.e., a doctor's note or LOMN that specifically identifies that the recommendation and expense is for treatment of the medical condition) with the request for reimbursement. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition. Artificial Insemination (active attempt to conceive) When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Artificial Reproductive Technologies (active attempt to conceive) When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Automobile Modifications (for medical condition) A health care professional must provide evidence of medical necessity for the cost of car modifications such as hand controls and other special equipment installed in a car including installation costs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car.Baby Formula
For the cost of baby formula to be an eligible medical expense, a health care professional must provide evidence of medical necessity showing that the qualified employee’s infant requires special dietary requirements, and a specific baby formula is recommended to treat the illness or disorder. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is calculated using a cost difference method of subtracting the amount paid for standard baby formula from the cost of the special formula. Baldness Treatment (for medical condition) A health care professional must provide evidence of medical necessity such as the result of chemotherapy treatment, disease, trauma or injury for the cost of treatment, for baldness to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Bariatric Surgery
A health care professional must provide evidence of medical necessity for the cost of bariatric surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Behavioral Modification Programs A health care professional must provide evidence of medical necessity for the cost of special and residential schools/programs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments for a special program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school/program may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birthdefect.
Bio-identical Hormone Replacement Therapy (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Bio-identical Hormone Replacement Therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Birthing Coach
A health care professional must provide evidence of medical necessity for the cost of a birthing coach who provides medical care for the mother or child to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Blepharoplasty (for medical condition) A health care professional must provide evidence of medical necessity for Blepharoplasty to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Blood Donor Fee
A health care professional must provide evidence of medical necessity for the cost of blood donation to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: A fee associated with blood donation is an eligible medical expense when the blood is for use by the participant, spouse or eligible dependent.Blood Storage
A health care professional must provide evidence of medical necessity for the cost of blood storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to store blood would be an eligiblemedical expense.
Body Restoration Technique A health care professional must provide evidence of medical necessity for the cost of body restoration to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Botox Injections (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Botox injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note of LOMN must specifically identify the recommendation and expense is for treatment of the medical condition (i.e. treatment of migraines). Breast Implants or Removal (for medical condition) A health care professional must provide evidence of medical necessity for the cost of breast implants or removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Breast Reduction (for medical condition) A health care professional must provide evidence of medical necessity for the cost of breast reduction surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Calcium (for medical condition) A health care professional must provide evidence of medical necessity for the cost of calcium to be an eligible medical expense. Include a doctor's note or Letter of Medical (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Capital Expense (cost of installing equipment in home) A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as a ramp or wheelchair lift) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 atwww.irs.gov .
Car Modification (for medical condition) A health care professional must provide evidence of medical necessity for the cost of car modifications such as hand controls and other special equipment installed in a car including installation costs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Cervical Pillow
A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Chairs, Reclining
A health care professional must provide evidence of medical necessity for the cost of a reclining chair to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is calculated using a cost difference method of subtracting the amount paid for a standard chair from the cost of a specialized chair.Chelation Therapy
A health care professional must provide evidence of medical necessity such as lead poisoning for the cost of chelation therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Club Dues and Fees (for medical condition) A health care professional must provide evidence of medical necessity for the cost of dues paid to a health club or gym to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is only for the individual membership and for the component that is related to the current plan year. Any dues that carry over to another plan year must be submitted for that plan year of coverage. Even if you're required to prepay for an entire year, membership fees may only be reimbursed each month. Collagen Injections (for medical condition) A health care professional must provide evidence of medical necessity such as urinary incontinence or severe acne for the cost of collagen injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Colon Therapy, Colon Hydrotherapy, Colonics A health care professional must provide evidence of medical necessity for the cost of colon therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Convalescent Home (medical care, meals & lodging) A health care professional must provide evidence of medical necessity for the cost of medical care provided during a temporary stay in a convalescent, nursing home or skilled facility, (e.g., following a hospital stay or surgery) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the convalescent/nursing home if the main reason for being there is to receive medical care in order to return home. If participant resides permanently in the facility, only separately stated medical expenses would be eligible for reimbursement (e.g. individually billed doctor visits; prescription costs). Cord Blood (harvesting/storage for medical condition) A health care professional must provide evidence of medical necessity with the infant or other family member covered under the health care account, for the cost of harvesting and storing cord blood to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect, freeze and store umbilical cord blood would be an eligible medical expense. Cosmetic Treatment (for medical condition) A health care professional must provide evidence of medical necessity such as improve a deformity arising from, or directly related to, a congenital abnormality, personal injury or disfiguring disease, for the cost of cosmetic surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Crania-Sacral Therapy A health care professional must provide evidence of medical necessity for the cost crania-sacral therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Dance Lessons (for medical condition) A health care professional must provide evidence of medical necessity for the cost of fees paid for lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Dental Treatment (tooth bonding) A health care professional must provide evidence of medical necessity for tooth bonding to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Dependent Care (for disabled person) A health care professional must provide evidence of medical necessity for the cost of care for a disabled dependent to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Diapers, Diaper Service A health care professional must provide evidence of medical necessity for the cost of diapers and diaper service to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. However, the cost of an incontinence product is an eligible medical expense. Examples include, but are not limited to: Depend, Invacare, Poise, Prevail, Serenity. Dietary Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Dietician
A health care professional must provide evidence of medical necessity for the cost of dietician to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Digestive Aids (for medical condition) A health care professional must provide evidence of medical necessity for the cost of digestive aids to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Disabled Dependent Care A health care professional must provide evidence of medical necessity for the cost of care for a disabled dependent to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Doula Fees
A health care professional must provide evidence of medical necessity for the cost of a doula who provides medical care for the mother or child to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Dyslexia Treatment
A health care professional must provide evidence of medical necessity for dyslexia treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Educational Classes (for medical condition) The cost of an educational class specific to a medical condition such as learning to manage diabetes or learning Braille is a qualified medical expense. Submit evidence of the medical condition as well as the class description with the request for reimbursement. Egg and Embryo Storage Fees A health care professional must provide evidence of medical necessity for the cost of eggs and embryo storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to store eggs and embryos would be aneligible expense.
Egg and Sperm Donor Fees When associated with an active attempt to conceive, amounts paid for egg and sperm donation are eligible medical expenses. A health care professional must provide evidence of medical necessity for the cost of egg and sperm donor fees to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The donor fee, agency fee, donor's medical and psychological testing, as well as legal contract fees are eligible if medically necessary for the procedure to be performed on you, your spouse or eligible dependent.Egg Recipient Fees
A health care professional must provide evidence of medical necessity for the egg recipient fees (legal, recipient testing and agency fees) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify how a patient's reproductive problems related to their medical condition results in the need for receiving eggs. Note: The egg recipient fees are eligible if medically necessary for the procedure to be performed on you, your spouse or eligible dependent. Electrolysis (hair removal for medical condition) A health care professional must provide evidence of medical necessity for the cost of hair removal or a hair transplant to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Elevator
A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as an elevator) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov.
Excess Skin Removal
A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Exercise Equipment, Exercise Program (for medical condition) A health care professional must provide evidence of medical necessity for the cost of exercise equipment/wearable technology, including a Fitbit, or an exercise program, including Wii games to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the type/name of the equipment or program is for treatment of the medical condition. If you can provide an itemized receipt separating the cost of the additional feature(s), only the amount of those additional features would be eligible for reimbursement. If you cannot provide an itemized statement showing the cost of the additional feature(s), the full cost of the product is not eligible for reimbursement. Products include but not limited to: Tom Tom, iWatch, Moto 360, Smart Watches, Android, LG, Tag Heuer. Note: The cost of a computer or Wii console would not eligible for reimbursement as they are dual purpose. Fertility Enhancement and Treatments When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as you, your spouse or a eligible dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Fiber Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Fitness Program (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a fitness program to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the program is for treatment of the medicalcondition.
Fluoride Device and Treatment (In home or Office) A health care professional must provide evidence of medical necessity for the cost of home water fluoride treatment, including installation and rental charges to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Gambling Treatment
A health care professional must provide evidence of medical necessity for the cost of gambling treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Gastric Bypass Surgery Including Excess Skin Removal (for medicalcondition)
A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. GIFT (Gamete intrafallopian transfer) When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as you, your spouse or a eligible dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Hair Removal or Transplant (for medical condition) A health care professional must provide evidence of medical necessity for the cost of hair removal or a hair transplant to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Half Way House
A health care professional must provide evidence of medical necessity for the cost of treatment for alcoholism or substance abuse in a Half Way House to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Health Club or Gym Membership Fees (for medical condition) A health care professional must provide evidence of medical necessity for the cost of dues paid to a health club or gym to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is only for the individual membership and for the component that is related to the current plan year. Any dues that carry over to another plan year must be submitted for that plan year of coverage. Even if you're required to prepay for an entire year, membership fees may only be reimbursed each month. Herbs and Herbal Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Holistic, Homeopathic Professional (for medical condition) Treatments provided by non-traditional alternative healer professionals (like holistic, homepathic professionals) are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition.Home Improvements
A health care professional must provide evidence of medical necessity for the cost of home improvement to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov . Homeopathic Care and Medicines Treatments provided by non-traditional alternative healer professionals (like homeopathic care and medicines) are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition. Hormone Replacement Therapy (HRT) (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Hormone Replacement Therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Hydrotherapy
A health care professional must provide evidence of medical necessity for the cost of hydrotherapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Hyperbaric Oxygen Therapy A health care professional must provide evidence of medical necessity for the cost of hyperbaric oxygen to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Hypnosis
A health care professional must provide evidence of medical necessity for the cost of hypnosis to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Impotence
A health care professional must provide evidence of medical necessity for the cost of treatment for impotence or sexual dysfunction (male or female) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
In Vitro Fertilization When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Inclinator
A health care professional must provide evidence of medical necessity for the cost of an inclinator to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Infertility Treatments When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Injection Snore Plasty A health care professional must provide evidence of medical necessity for the cost of snore plasty to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Inversion Table
A health care professional must provide evidence of medical necessity for the cost of an inversion table to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Joint Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of joint supplements to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Kenalog injections (for medical condition) A health care professional must provide evidence of medical necessity for the cost of kenalog injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Kinesiology
A health care professional must provide evidence of medical necessity for the cost of kinesiology to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Laetrile
A health care professional must provide evidence of medical necessity for the cost of laetrile (sometimes called vitamin B17) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Language Classes
A health care professional must provide evidence of medical necessity for the cost of language classes to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Lap Band Surgery (for medical condition) A health care professional must provide evidence of medical necessity for lap band surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Lead Paint Removal (for medical condition) A health care professional must provide evidence of medical necessity for the cost of lead paint removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Learning Disabilities A health care professional must provide evidence of medical necessity for the cost of special schools/programs for the learning disability to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a school/program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments to a special school/program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect. Lessons (for medical condition) A health care professional must provide evidence of medical necessity for the cost of fees paid for lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Life Coach
A health care professional must provide evidence of medical necessity for the cost of a life coach to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Liposuction (for medical condition) A health care professional must provide evidence of medical necessity for liposuction to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Lumbar Support
A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Massage Therapy (for medical condition) A health care professional must provide evidence of medical necessity for the cost of massage therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Mattress
A health care professional must provide evidence of medical necessity for the cost of a mattress to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimburssement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Only the amount that exceeds the cost of a regular mattress is reimbursable. We reimburse the cost difference between the standard product and specialty product. The member needs to provide the cost difference (e.g., sales flyer) of a standard mattress for us to reimburse the difference between thecosts.
Medical Conference (admission and transportation) A health care professional must provide evidence of medical necessity for the cost of admission and transportation to the conference to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the medical conference is required for the treatment of a medical condition of the account holder or a qualified dependent. Minerals, Mineral Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of minerals or mineral supplements to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Naturopathic Care, Naturopathic Healers (for medical condition) Treatments provided by non-traditional alternative healer professionals (like naturopathic care and healers) are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition. Nursing Home (medical care, meals and lodging) A health care professional must provide evidence of medical necessity for the cost of medical care provided during a temporary stay in a convalescent, nursing home or skilled facility, (e.g., following a hospital stay or surgery) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the convalescent/nursing home if the main reason for being there is to receive medical care in order to return home. If participant resides permanently in the facility, only separately stated medical expenses would be eligible for reimbursement (e.g. individually billed doctor visits; prescription costs). The cost of custodial care in a convalescent or nursing home (e.g., long term care) is not an eligiblemedical expense.
Nutritional Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of nutritional supplements to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Nutritionist (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a nutritionist to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Orthopedic Shoes
A health care professional must provide evidence of medical necessity for the cost of orthopedic shoes to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Only the cost difference of the specialized orthopedic shoe over the cost of an equivalent regularshoe is eligible.
Pedometer
A health care professional must provide evidence of medical necessity for the cost of a pedometer to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Penile Implants
A health care professional must provide evidence of medical necessity for penile implants to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Personal Trainer Fees (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a personal trainer to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Phototherapy
A health care professional must provide evidence of medical necessity for the cost of phototherapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Pillows for Lumbar and Cervical Support A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Probiotics (for medical condition) A health care professional must provide evidence of medical necessity for the cost of probiotics to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Progesterone, Testosterone Hormones (for medical condition) A health care professional must provide evidence of medical necessity for the cost of progesterone and testosterone to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Propecia (for medical condition) A health care professional must provide evidence of medical necessity for the cost of propecia to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Purifier
A health care professional must provide evidence of medical necessity for the cost of a purifier to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Reflexology
A health care professional must provide evidence of medical necessity for the cost of reflexology to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Rehabilitation Center (meals and lodging) A health care professional must provide evidence of medical necessity for the cost of follow-up medical care after a hospital stay, surgery or an injury at a rehabilitation center or facility to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the rehabilitation center if the main reason for being there is to receive medical care. Note: Lodging while receiving temporary care would be an eligible expense if the individual is receiving medical treatment and not their permanentresidence.
Retin-A (for medical condition) A health care professional must provide evidence of medical necessity for the cost of Retin-A to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Rogaine (for medical condition) A health care professional must provide evidence of medical necessity for the cost of propecia to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Rolfing, Structural Integration A health care professional must provide evidence of medical necessity for the cost of rolfing to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Scale, food or weight A health care professional must provide evidence of medical necessity for the cost of a food scale or weight scale to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Schools, Special
A health care professional must provide evidence of medical necessity for the cost of special and residential schools to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a school, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments to a special school are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect.Sexual Counseling
A health care professional must provide evidence of medical necessity for the cost of sexual therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Sexual Dysfunction
A health care professional must provide evidence of medical necessity for the cost of treatment for impotence or sexual dysfunction (male or female) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The cost for the treatment of erectile dysfunction is an eligible medical expense. This includes but not limited to prescribed medications: Viagra, Cialis, Levitra. Skin Tag Removal (for medical condition) A health care professional must provide evidence of medical necessity for the cost of skin tag removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Special Computer Program for the Blind A health care professional must provide evidence of medical necessity for the cost of special computer programs for the blind to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The computer itself would not be covered because of the general purpose it could pose for all family members.Special Food
A health care professional must provide evidence of medical necessity for the cost of special foods to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The amount that is reimbursable is the cost difference of normal food and the amount paid for the specialized food. The participant must provide the cost difference. Keep in mind, special foods do not include diet food or meal replacements such as shakes for weight loss programs. Speech Therapy (dvds, videos, software) A health care professional must provide evidence of medical necessity for the cost of DVDs, videos or special software to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The cost of the computer, Wii, etc. is not an eligible medical expense. Sperm Storage (for medical reasons) A health care professional must provide evidence of medical necessity for the cost of sperm storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Cost to store sperm for future implantation where you have no medical condition, is not an eligible medical expense. Stem Cell Harvesting or Storage (for medical reasons) A health care professional must provide evidence of medical necessity for the cost of harvesting and storing stem cells to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect and store stem cells would be an eligible medical expense. Stem Cell Injections A health care professional must provide evidence of medical necessity for the cost of stem cell injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Supplement (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Supplements include but are not limited to: dietary, fiber, joint, and nutritional. Swimming Lessons (for medical condition) A health care professional must provide evidence of medical necessity for the cost of fees paid for swimming lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Swimming Pool (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a swimming pool to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov . Syntonic Phototherapy A health care professional must provide evidence of medical necessity for the cost of syntonic phototherapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Tanning Salon Visits or Equipment (for medical condition) A health care professional must provide evidence of medical necessity for the cost of tanning salon sessions or equipment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Transportation (for nurse or companion) The cost of a nurse or companion's transportation expeses may be an eligible medical expense, if recommended by a health care professional for a medical condition. You must include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify the medical condition and that the expense is for treatment of the medical condition of a covered individual that is unable to travel alone and requires the assistance of a nurse or companion (e.g., a parent or spouse). Transportation (to attend Alcoholics Anonymous) A health care professional must provide evidence of medical necessity for the cost of fees and transportation to attend Alcoholics Anonymous (AA) meetings to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medicalcondition.
Tuition (for special school/program) A health care professional must provide evidence of medical necessity for the cost of special and residential schools/programs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments for a special program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school/program may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birthdefect.
Tutoring
Expenses for hiring a tutor may be eligible for reimbursement if you, your spouse or eligible dependent has been diagnosed with a learning disability caused by mental or physical impairments. This also includes nervous system disorders. Learning disabilities diagnosed by a medical professional can allow for the medical professional to write a Letter of Medical Necessity (LOMN) stating that a specially trained tutor is required to help the learning-disabled individual receive an education. Examples include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect. Umbilical Cord Blood (harvesting/storage for medical condition) A health care professional must provide evidence of medical necessity with the infant or other family member covered under the health care account, for the cost of harvesting and storing cord blood to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect, freeze and store umbilical cord blood would be an eligible medical expense.UVR treatments
A health care professional must provide evidence of medical necessity for the cost of ultra violet light treatments to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Varicose Veins Treatment (for medical condition) A health care professional must provide evidence of medical necessity for the cost of varicose vein removal or treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Vitamin (for medical condition) A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.Waterpik
Waterpiks, when prescribed by Licensed Dentist for a medical condition like gingivitis, may be reimbursable with a doctor's note or Letter of Medical Necessity (LOMN). Weight Loss Drugs, Medicines (over-the-counter for medical condition) A health care professional must provide evidence of medical necessity for the cost of over-the-counter (OTC) weight loss drugs, like Alli to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Weight Loss Programs (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a weight loss program to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: This includes the cost of the class or meeting as well as the fees to join; not the food or books. The cost is eligible as each meeting or session is attended, or for the monthly membership pass. In other words, even if you prepay for the entire program (such as a 17-week pass), you may only get reimbursed as you complete each class.Whirlpool Baths
A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as a whirlpool path) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 atwww.irs.gov .
Wig (for medical condition) A health care professional must provide evidence of medical necessity for the cost of a wig and certain maintenance items like glue, wig tape or under cap to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of themedical condition.
Ineligible
Abdominoplasty (for cosmetic reasons) Generally, the cost of an abdominoplasty is not an eligible medical expense. This procedure may also be known as a Tummy Tuck. The cost of cosmetic surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: adominoplasty, breast augmentations, enhancement, electrolysis (hair/removal), face lift, hair transplant, liposuction, tattoo removal, collagen injections. Acne (routine skin care) Cost of routine skin care is not an eligible medical expense. Adoption Medical Expenses (incurred before adoption negotiations) Fees relating to the adoption process and fees for medical expenses incurred prior to beginning adoption negotiations are not eligiblemedical expenses.
Adoption Medical Expenses (incurred by birth mother, associated withbirth)
Expenses incurred by the birth mother associated with an adopted baby’s birth are not eligible medical expenses. Allergy Products (used even without allergies) If the product would be owned even without allergies (such as a pillow or vacuum cleaner), the expense is generally not an eligible expense. Alternative Medicine, Alternative Healers (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Appearance Improvement Appearance improvement for cosmetic reasons is not an eligible medical expense. The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense because it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Assisted Living Facility Living expenses in an assisted living facility for permanent residence are not eligible medical expenses. Automobile Modifications (cost of operating the car) The cost of operating a specially equipped car is not an eligiblemedical expense.
Autopsy
Fees associated with an autopsy are not eligible medical expenses. Babysitting, Child and Dependent Care (for healthy child) The cost of babysitting, child care and nursing services for a healthy child or dependent are not eligible medical expenses. Baldness Treatment (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Bariatric Surgery (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Bio-identical Hormone Replacement Therapy (used as an enhancement) Hormone replacements used as an enhancement for body-builders, athletes and others are not eligible medical expenses. Birthing Classes (not related to the actual childbirth) The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breastfeeding vs. bottle feeding, newborn care) is not an eligible medical expense. Bleaching or Whitening Teeth The cost of bleaching or whitening teeth is not an eligible medicalexpense.
Blepharoplasty (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Botox Injections (for cosmetic reasons) Amounts paid for cosmetic services, such as Botox injections to eliminate wrinkles, are not eligible medical expenses. Boutique, Concierge, Practice Fees The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care isneeded.
Breast Augmentation (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Breast Implants or Removal (for cosmetic reasons) The cost to replace a cosmetic implant (i.e. reduction or enlargement) is not an eligible medical expense. Breast Reduction (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Calcium (for general health) When calcium is taken for general good health (even when recommended by a health care professional), the amounts paid for calcium are not eligible medical expenses. Car Modification (cost of operating the car) The cost of operating a specially equipped car is not an eligiblemedical expense.
Chemical Peel (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Childbirth Classes/Lamaze (not related to the actual childbirth) The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breastfeeding vs. bottle feeding, newborn care) is not an eligible medical expense. Chinese Herbal Practioner and Herbal Treatments (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Christian Science Treatments (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Club Dues and Fees (for general health/non-medical) Health club dues paid for general health or to relieve physical or mental discomfort not related to a medical condition are not eligiblemedical expenses.
COBRA Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible healthcare FSA expenses.
Cold and Hot Packs (for non-medical use) When used for other purposes (e.g., to keep beverages hot or cold), amounts paid for cold and hot packs are not eligible medical expenses. Cold Sore and Fever Blister Treatments (lip balm SPF lower than 15) The cost of medicated lip balm with no SPF or an SPF lower than 15 is not an eligible medical expense. Collagen Injections (for cosmetic reasons) The cost of collagen injections for cosmetic purposes is not an eligible medical expense.Concierge Medicine
The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care isneeded.
Contact Lens Service Agreement and Warranty Any fees for vision discount programs or warranties are not eligiblemedical expenses.
Contact Lenses and Supplies (for cosmetic reasons) Amounts paid for cosmetic contact lenses (such as to change eye color without vision correction) are not eligible medical expenses. Controlled Substances The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible. Convalescent Home (custodial care) The cost of custodial care in a convalescent or nursing home (e.g., long term care) is not an eligible medical expense. Cord Blood (harvesting/storage for non-medical reasons) Storage and harvesting fees paid for non-medical reasons or to preserve the cord blood for future use are not eligible medicalexpenses.
Cosmetic Treatment (for non-medical reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Counseling (marriage/family for non-medical reasons) Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses.CPR
The cost of a CPR class is not an eligible medical expense. Dance Lessons (non-medical) Fees paid for lessons not recommended by a health care professional or not specific to a medical condition are not eligible medical expensesDehumidifier
The cost of a dehumidifier is not an eligible medical expense. Dental Maintenance Organization (DMO) Fees (if you have a health careFSA)
Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Dental Treatment (oral hygiene & supplies) Ineligible items include, but are not limited to: toothpaste, toothbrushes (including a specialized or battery-powered toothbrush), oral hygiene products such as oral rinses, veneers for cosmetic purposes and cost of cosmetic dental treatments.Dental, cosmetic
The cost of cosmetic dental treatment is not an eligible medicalexpense.
Dentures (for cosmetic reasons) Cosmetic dentures are not an eligible medical expense. Dependent Care (for healthy child) The cost of babysitting, child care and nursing services for a healthy child or dependent are not eligible medical expenses. Dermabrasion (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Dermatology (for cosmetic reasons) Amounts paid to a dermatologist for cosmetic services (such as botox injections to eliminate wrinkles) are not eligible medical expenses.Diet Food
The cost of food, including diet food or meal replacements such as shakes for weight loss programs, is not an eligible medical expense to the extent it is for ordinary nutritional value. Therefore the cost of food associated with weight-loss programs, such as pre-packed meals and diet food, is not eligible since the food is a substitute for regular food and meets normal nutritional needs. Dietary Supplement (for general health) When dietary supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for supplements, herbs, minerals, and vitamins are not eligible medicalexpenses.
Digestive Aids (for general health) When digestive aids are taken for general good health (even when recommended by a health care professional), the amounts paid for digestive aids are not eligible medical expenses. DNA Collection and Storage (for paternity testing) The cost of a DNA test to determine paternity is not an eligiblemedical expense
Drugs (controlled substances) The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible.Ear, Body Piercing
The cost of ear or body piercing is not an eligible medical expense. Educational Classes (non-medical/general well-being) The cost of an educational class not specific to a medical condition or for general well-being (such as care for newborn) is not an eligible medical expense. Electrolysis (hair removal for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Electronic Cigarettes The cost of an electronic cigarette is not an eligible medical expense. It is not an approved smoking cessation product but rather areplacement.
Exercise Equipment, Exercise Program (for general health) The cost of exercise equipment or an exercise program for improvement of general health is not an eligible medical expense Expenses not incurred during the coverage period Expenses not incurred during the coverage period or before the HSA account is opened are not eligible medical expenses. Expenses that have been reimbursed previously under or could be reimbursed under another medical plan Expenses that have been reimbursed previously under or could be reimbursed under another medical plan are not eligible medicalexpenses.
Eye Care, Eyeglasses (warranties) The cost of warranties for eyeglass repairs and replacements is not an eligible medical expense. Eye Exams, Eyeglasses, Eye Surgery, Eye Care (not needed for visioncorrection)
Amounts paid for over-the-counter sunglasses, as well as eyeglasses not needed for vision correction or reading, are not eligible medicalexpenses.
Face Lift (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Fertility Enhancement and Treatments (fees for preserving) Fees paid for preserving semen or embryos for future generations (including for genetic information) are not eligible medical expenses. Fertility Enhancement and Treatments (surrogate or gestationalcarrier expenses)
Surrogate or gestational carrier expenses are generally not eligible expenses for the participant. Fiber Supplement (for general health) When fiber supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for fiber supplements are not eligible medical expenses.Finance Charges
Fees that are finance charges for unpaid medical expenses are not eligible medical expenses. Fitness Program (for general health) The cost of a fitness program for improvement of general health is not an eligible medical expense. Fluoride Rinse, Pills and Toothpaste Fluoride rinse, pills and toothpaste are not eligible medicalexpenses.
Food
The cost of food, including diet food or meal replacements such as shakes for weight loss programs, is not an eligible medical expense to the extent it is for ordinary nutritional value. Therefore the cost of food associated with weight-loss programs, such as pre-packed meals and diet food, is not eligible since the food is a substitute for regular food and meets normal nutritional needs.Forms Completion
Charges incurred for provider completion of forms is not an eligible medical expense. Including, but not limited to the following examples: disability form, FMLA form, sports participation form, camp formFounder’s Fees
A lifetime care advance payment (also known as a founder's fee) is not an eligible medical expense.Funeral Expenses
The cost of a funeral is not an eligible medical expense. Gastric Bypass Surgery Including Excess Skin Removal (for cosmeticreasons)
The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Hair Removal or Transplant (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. HDHP, High-deductible health plan (premiums) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a high-deductible health plan (HDHP) and premiums paid as part of a Section 125 payroll reduction plan, are not eligible medical expenses. Health Club or Gym Membership Fees (for general health/non-medical) Health club dues paid for general health or to relieve physical or mental discomfort not related to a medical condition are not eligiblemedical expenses.
Herbs and Herbal Supplement (for general health) When herbs or herbal supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for herbs or herbal supplements are not eligible medicalexpenses.
HMO, Health Maintenance Organization (premiums) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible medicalexpenses.
Holistic, Homeopathic Professional (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Homeopathic Care and Medicines (for general health) Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses. Hormone Replacement Therapy (HRT) (used as an enhancement) Hormone replacements used as an enhancement for body-builders, athletes and others are not eligible medical expenses.Household Help
The cost of household help, even if recommended by a health care professional, is not an eligible medical expense. However, amounts paid for nursing services are eligible medical expenses. Illegal Operations, Illegal Treatments The cost of an illegal operation or other treatment is not an eligiblemedical expense.
Insurance Premiums (for Medicare supplement policies) Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Insurance Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Joint Supplement (for general health) When joint supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for joint supplements are not eligible medical expenses. Kenalog Injections (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Lamaze Classes (not related to the actual childbirth) The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breast feeding vs. bottle feeding, newborn care) is not an eligible medical expense. Lap Band Surgery (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.Late Payment Fee
A late fee associated with a medical payment is not an eligiblemedical expense.
Lead Paint Correction (repaint affected area) The cost to repaint the affected area is not a eligible medicalexpense.
Legal Fees (for adoption) Legal fees for adoption are not eligible medical expenses. Legal Fees (for divorce) Legal fees to obtain a divorce are not eligible medical expenses. Legal Fees (for guardian/estate) Guardianship and estate management fees are not eligible medicalexpenses
Legal Fees (for surrogate mother) Legal fees in connection with a surrogate mother are not eligiblemedical expenses.
Lessons (non-medical) Fees paid for lessons not recommended by a health care professional or not specific to a medical condition are not eligible medical expenses Lip Balm (SPF lower than 15) The cost of lip balm (regular/standard or medicated) with no SPF or an SPF lower than 15 is not an eligible medical expense. Liposuction (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Lodging and Trips (for general health) Amounts paid for a trip or vacation taken for a change in environment, improvement of morale or general improvement of health, even if recommended by a doctor, are not eligible medical expenses. Long Term Care Insurance Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Long Term Disability (LTD) Insurance Premiums (if you have a healthcare FSA)
Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses.Marijuana
The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible.Marriage Counseling
Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses. Massage Therapy (for general health) The cost of massage therapy that is for general health is not an eligible medical expense.Maternity Clothes
The cost of maternity clothing is not an eligible medical expense. Meals (for a companion) Amounts paid for the meals for a companion are not eligible medicalexpenses.
Medical Newsletter
The cost of a medical newsletter is not an eligible medical expense. A newsletter does not directly treat a medical condition. Medical Services (monthly/annual fee) The cost of a monthly or annual fee for services even if they are never used, is not an eligible medical expense. Medicare Parts A, B and D (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible healthcare FSA expenses.
Medicated Lip Product (lip balm lower than SPF 15) The cost of medicated lip balm with no SPF or an SPF lower than 15 is not an eligible medical expense. Medicine and Drugs from Other Countries (purchased in another countryfor use in U.S.)
The cost of medicine or drugs purchased from another country for use in this country is not an eligible medical expense, unless the Food and Drug Administration (FDA) announces that a prescribed drug can be legally imported by individuals. Medicine, Prescription (for cosmetic reasons) The cost of prescriptions for cosmetics drugs are not an eligiblemedical expense.
Micro-Dermabrasion (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Minerals, Mineral Supplement (for general health) When minerals or mineral supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for minerals or mineral supplements are not eligible medicalexpenses.
Missed Appointment Fees A fee paid for a missed appointment is not an eligible medicalexpense.
Naturopathic Care, Naturopathic Healers (for general health) Alternative treatments, healers, drugs and medicines for general health are not eligible expenses. Newborn Nursing Care Cost for nursing care services of a healthy infant are not an eligiblemedical expense.
Nursing Pillows or Covers The cost of nursing pillows or other personal items and accessories are not eligible medical expenses. This includes but is not limited to: nursing covers, Boppy pillow, etc. Nutritional Supplement (for general health) When nutritional supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for nutritional supplements are not eligible medical expenses. Nutritionist (for general well-being) Amounts paid to a nutritionist for general well-being, even when recommended by a health care professional, are not eligible medicalexpenses.
Obstetrical Care (prepaid expenses for the birth) Prepaid expenses for the birth are not eligible until the baby is born and insurance has paid. The incurred date is considered the date of birth to avoid overpayment situations and crossing of plan years. Operation (for cosmetic reasons) The cost of cosmetic surgery is not an eligible medical expense. Organ Recipient Expenses (paid by the donor) Expenses related to the organ recipient and paid by the donor are not eligible medical expenses, if they are not covered by a health careFSA, HSA or HRA.
Pastoral Counseling
Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses.Paternity Testing
The cost of a DNA test to determine paternity is not an eligiblemedical expense
Personal Items
Products used for personal grooming and hygiene are not eligiblemedical expenses.
Personal Trainer Fees (for general health) Fees paid to a personal trainer for improvement of general health (even when recommended by a health care professional) are not eligiblemedical expenses.
Physical Exam for Caregiver The cost of a physical exam for a potential caregiver is not an eligible medical expense. Physician Fees, Pre-Paid The cost of prepaid physician fees to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care is needed. Premiums (for Medicare supplement policies) Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap. Premiums (if you have a health care FSA) Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to an HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses.Pre-Paid Payments
A prepayment for medical care is not reimbursable until you have received the care. Internal Revenue Service (IRS) guidelines require services to be incurred before expenses can be reimbursed. Prescription Drug Discount Program The costs to have access to reduced cost prescriptions are not eligible medical expenses. These are viewed as a type of insurance. Probiotics (for general health) When probiotics are taken for general good health (even when recommended by a health care professional), the amounts paid for probiotics are not eligible medical expenses. Progesterone, Testosterone Hormones (for cosmetic reasons) Progesterone or testosterone used for cosmetic purposes or body building are not an eligible medical expense. Propecia (for cosmetic reasons) Propecia used for cosmetic purposes is not an eligible medicalexpense.
Rehabilitation Center (custodial care for permanent residence) The cost of custodial care in a rehabilitation center or nursing home for permanent residence is not an eligible medical expense. Restylane Injections (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.Retention Fees
The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care isneeded.
Retin-A (for effects of aging) When prescribed for the effects of aging, the cost of Retin-A is not an eligible medical expense. Rhinoplasty (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Rogaine (for cosmetic reasons) If used for cosmetic purposes, Rogaine is not an eligible medicalexpense.
Shampoos and Soaps
Products used for personal grooming and hygiene (like shampoos and soaps) are not eligible medical expenses. Skin Tag Removal (for cosmetic reasons) If the procedure is for cosmetic purposes, skin tag removal is not an eligible medical expense. Sperm Storage (for non-medical reasons) Storage fees paid for non-medical reasons or to preserve the sperm for future generations (such as for genetic information) are not eligiblemedical expenses.
Stem Cell Harvesting or Storage (for non-medical reasons) Storage and harvesting fees paid for non-medical reasons or to preserve the stem cells for future use are not eligible medicalexpenses.
Student Health Fee (fees/premium for program) Fees for belonging to the program or as premium for future health care needs are not eligible medical expenses. Sunglasses (no vision correction) The cost for over-the-counter sunglasses (no vision correction) is not an eligible medical expense. Sunscreen (lower than SPF 15) The cost of an over-the-counter sunscreen product with SPF lower than 15 or for lotions and cosmetics that contains sunscreen is not an eligible medical expense. Supplement (for general health) When supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for supplements, herbs, minerals, and vitamins are not eligible medicalexpenses.
Surgery (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Surrogate Mother Fees (for medical expenses for the surrogate) If the plan participant is using a surrogate mother, the medical expenses incurred by the surrogate mother are not eligible medical expenses of the plan participant, since the surrogate mother is not a covered individual under the participant’s plan. Surrogate Mother Fees (for search of surrogate) Fees paid to an agency to search for a surrogate mother are not eligible medical expenses. Swimming Lessons (non-medical) Fees paid for swimming lessons not recommended by a health care professional or not specific to a medical condition are not eligiblemedical expenses
Swimming Pool (for recreation) The cost of a pool is not an eligible medical expense if the pool is used for recreation. Tanning Salon Visits or Equipment (for cosmetic reasons/appearance) The cost of tanning salon sessions or equipment for personal use and appearance is not an eligible medical expense. Tattoo Removal (for cosmetic reasons) The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections. Telephone for Hearing Impaired (cost of phone in hospital/treatmentcenter)
The cost of a telephone while in a hospital or treatment center is not an eligible medical expense. Television for Visually or Hearing Impaired (cost of TV in hospital/treatment center) The cost of a television while in a hospital or treatment center is not an eligible medical expense. Temporary Continuation of Coverage (TCC) Premiums (if you have ahealth care FSA)
Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Therapy (marriage/family for non-medical reasons) Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses. Toiletries (Personal Hygiene) Amounts paid for toiletries (e.g., cologne, dental floss, deodorant, lotion, shaving cream, shampoo, soap, toothpaste, etc.) are not eligible medical expenses.Toothbrushes
The cost of a toothbrush (including a specialized or battery-powered toothbrush), even when recommended by a dentist for a medical condition, is not an eligible medical expense. Transportation (non-medical) Regular (non-medical) commuting costs for an individual with a physical disability are not eligible medical expenses. Transportation Cost of Disabled Individual Commuting To and From Work A disabled individual's commuting costs to and from work are not eligible medical expenses. Tri-Care Premiums (if you have a health care FSA) Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses. Trips (for general health) Amounts paid for a trip or vacation taken for a change in environment, improvement of morale or general improvement of health (even if recommended by a doctor) are not eligible medical expenses.Tummy Tuck
Generally, the cost of a Tummy Tuck is not an eligible medical expense. In order to be considered an eligible expense, a health care professional must provide evidence of medical necessity for the cost of removal of excess skin. You must include a doctor's note or Letter of Medical Necessity with your request for reimbursement. The doctor's note or LOMN must specifically state that the recommendation and expense is for treatment of the medical condition. Ultrasound, Pre-Natal (non-medical request by patient) The cost of an ultrasound that is not ordered by a health care professional or is not intended to monitor the growth and condition of the fetus is not an eligible expense. Umbilical Cord Blood (harvesting/storage for non-medical reasons) Storage and harvesting fees paid for non-medical reasons or to preserve the cord blood for future use are not eligible medicalexpenses.
Varicose Veins Treatment (for cosmetic reasons) The cost to remove varicose veins for cosmetic purposes is not an eligible medical expense. Veneers (for cosmetic reasons) The cost of cosmetic veneers is not an eligible medical expense. Vision Discount Programs Fees to have access to a vision network that offers discounted items and services are not eligible medical expenses. Vitamin (for general health) When taken for general good health (even when recommended by a health care professional), amounts paid for supplements, herbs, minerals, and vitamins are not eligible medical expenses.Warranty
The cost of a warranty for example for vision or hearing aid equipment is not an eligible medical expense. Weight Loss Programs (for general health) The cost of a weight loss program associated with general weight loss (even when recommended by a health care professional) is not an eligible medical expense. Wig (styling or cleaning products) The cost for styling or cleaning products for a wig would be personal expenses and is not an eligible medical expense. footnote1Promotional offers, available in-store at CVS Pharmacy or online at CVS.com for eligible PayFlex HSA/FSA members. footnote2You’ll want to add up your total health care expenses per year. These may include: MEDICAL: deductibles, copays, co-insurance, health care provider visits, prescription drugs, over-the-counter items, insulin, diabetes syringes and supplies, annual wellness exams, chiropractic treatments and other medical expenses DENTAL: checkups and cleanings, fillings, root canals, crowns, bridges, dentures, mouth surgery, orthodontics (braces) and otherdental expenses
VISION/HEARING: exams, eyeglasses, prescription sunglasses, contact lenses and cleaning solutions, corrective eye surgery (LASIK, cataract), hearing exams, hearing aids, batteries and other vision orhearing expenses
footnote3Savings estimates assume annual IRS FSA and HSA contribution limits or your total expenses, whichever is less. Talk with your employer to learn the exact limits for your plan. For this calculation, we used a savings of 21% to assume federal, state and social security taxes you may avoid with pretax contributions. This calculation is just an estimate. It isn’t tax advice. Ask your tax advisor to find out how much you might save by making pretax contributions. Actual tax savings depend on many things. Some of these include state and local tax rates, your tax bracket and the FICA taxrate.
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