Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| Abortion - FSA |
X
|
|
|
|
| Acupuncture - FSA |
X
|
|
|
|
| Adoption Fees - FSA |
|
|
X
|
|
| Air Purifiers - FSA |
|
X requires LMN
|
|
Download LMN
|
| Alcoholism/Drug/Substance Abuse Treatment-FSA |
X
|
|
|
|
| Allergy Products - FSA |
|
X requires RX
|
|
Examples include:
- Zyrtec
- Claritin
- Allegra
- Benadryl
Download OTC Reference Guide
|
|
Ambulance - FSA
|
X
|
|
|
|
| Artificial Reproductive Technologies - FSA |
X
|
|
|
|
| Automobile Modifications - FSA |
|
X requires LMN
|
|
Modifications needed to accomodate a physical handicap for you or a covered dependent are potentially eligible
Download LMN
|
| Baby Formula - FSA |
|
X requires LMN
|
|
Only the cost difference btw regular formula and the prescribed formula is eligible
Download LMN
|
| Band-Aids/Bandages - FSA |
X
|
|
|
|
| Before & After School Care - DCA |
X
|
|
|
|
| Birth Control - FSA |
X
|
|
|
Examples include:
- condoms
- diaphrams
- Ovulation kits
|
|
Blood Pressure Monitors - FSA
|
X
|
|
|
|
| Blood Storage - FSA |
|
X requires LMN
|
|
Blood storage is eligible if you're scheduled for an upcoming surgery which requires stored blood. Storage fees should not exceed six months.
Download LMN
|
| Body Scans - FSA |
X
|
|
|
CT, MRI, X-RAY |
| Braille Books/Magazine - FSA |
X
|
|
|
|
|
 Newly Eligible
Breast Pumps/Lactation Device and accessories - FSA
|
X
|
|
|
Please note you may not be able to purchase these items with your FlexCard at stores such as Babies R Us but you can purchase them along with any accessories and submit them for reimbursement.
|
| Camps (daytime) - DCA |
X
|
|
|
If enrolled for the primary care of your covered dependents while you and/or your spouse is at work |
| Camps (overnight) - DCA |
|
|
X
|
|
| Camps (soccer, baseball, football, etc.) - DCA |
X
|
|
|
If enrolled for the primary care of your covered dependents while you and/or your spouse is at work |
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Capital Expense - FSA |
|
X requires LMN
|
|
If the value of your home is not increased by the improvement, the entire expense is approved. If the value of your home is increased, only the cost difference between the increase of the value of your home and the expense is eligible. |
| Childbirth Classes - FSA |
X
|
|
|
Examples include:
- Breastfeeding classes
- Newborn or new infant care classes
- Parenting classes
- Lamaze classes
|
| Chiropractic Care - FSA |
X
|
|
|
Most chiropractic expenses are covered |
| Cialis - FSA |
X
|
|
|
|
| Circumcision - FSA |
X
|
|
|
|
| Cobra Premiums - FSA |
|
|
X
|
|
| Co-Insurance - FSA |
X
|
|
|
|
| Compression Hosiery/Socks - FSA |
X |
|
|
|
| Contact Lenses - FSA |
X
|
|
|
To correct vision. Colored contact lenses that are not corrective are not eligible. |
| Contact Lens Solutions - |
X |
|
|
Examples include
- Complete
- Bausch & Lomb
- Sensitive Eyes
- Re-Nu
- Opti-Free
|
| Co-Payments - FSA |
X
|
|
|
|
| Cord Blood Storage - FSA |
|
X requires LMN
|
|
Can be reimbursed if there is a specific medical condition it is being used to treat. Storage for "just in case" is not eligible. Storage fees must not exceed 12 months. |
| Cosmetic Procedures - FSA |
|
X requires LMN
|
|
Possibly covered if used to correct a deformity arising from a congenital abnormality, personal injury from accident or trauma are potentially covered. |
| Counseling - FSA |
X
|
|
|
Debt and marriage counseling are not eligible |
| Cough, Cold and Flu Products - FSA |
|
X requires RX
|
|
Examples include:
- Thera Flu
- Robitussin
- Sudafed
Download OTC Reference Guide
|
| Crutches - FSA |
X
|
|
|
|
| Daycare/ChildCare Services - DCA |
X
|
|
|
Daycare facility, In-home care and babysitters for your covered dependent under the age of 13 are eligible if the care is being provided so that you can work. If married, your spouse must also be working or going to school full-time. If you are divorced, you must be the custodial parent for more than 50% of the year.
Please note that advanced payment for care that has not yet been provided is NOT eligible until the care has been realized.
|
| Dancing Lessons - FSA |
|
|
X
|
|
| Dental Care - FSA |
X
|
|
|
Exams, cleanings, x-rays, bridges, crowns, fillings and root canals are eligible expenses. Does not include normal daily dental care such as toothbrushes, dental floss and mouthwash |
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Deductibles - FSA |
X |
|
|
|
| Dental Floss - FSA |
|
|
X |
|
| Diabetic Supplies - FSA |
X
|
|
|
Includes insulin, syringes, meters and test strips |
| Diaper Rash Creams - FSA |
|
X requires RX
|
|
|
| Diapers - FSA |
X
|
|
|
Adult diapers such as depends are eligible. Diapers for the routine care of newborns and toddlers are not eligible. |
| Dietary Supplements - FSA |
|
X requires LMN
|
|
Must be used to treat a specific medical condition or ailment. Multi-Vitamins used to promote general health are not covered. Meal replacement supplements are not eligible. Even if purchased from a doctor or chiropractor, a letter of medical necessity is still required.
Download LMN
|
| Discount Programs/Clubs |
|
|
X |
Vision providers typically offer discounts on their prices if you pay to join their membership club which offers discounts on future purchases. Please note that these expenses are not eligible under an FSA program, however, you can pay for them out of pocket so you don't lose out on the savings. |
| Doula - FSA |
|
X
|
|
If the doula is licensed health care professional, his or her fees can be reimbursed. |
| Drug Addiction Assistance - FSA |
X
|
|
|
Includes inpatient care facility fees such as food and lodging provided by a licensed addiction center are eligible as well as the cost of. Also included are the fees associated with outpatient facilities. |
| Ear Plugs - FSA |
|
X requires LMN
|
|
Must be prescribed to treat a specific medical condition such as the presence of middle/inner ear tubes. |
| Elder Care - DCA |
X
|
|
|
Adult must live with you at least 8 hours a day and be claimed as a dependent on your federal tax return. |
| Electrolysis - FSA |
|
|
X
|
|
| Electrolyte Replacements - FSA |
X
|
|
|
Examples include: Pedialyte |
| Eye Care - FSA |
X
|
|
|
Examples include:
- Eye patches
- Reading glasses
|
| Eye Drops - FSA |
|
X requires RX
|
|
Examples include:
- Visine
- Murine
- Opcon
- Patanol
|
| Eyeglasses/Eye Exams - FSA |
X
|
|
|
Examples include:
- RX sunglasses
- Reading glasses
- Lenses
- Frames
|
| Excercise equipment - FSA |
|
X requires LMN
|
|
If used to treat a specific medical condition or ailment |
| Excercise Programs - FSA |
|
X requires LMN
|
|
If used to treat a specific medical condition or ailment |
| Feminine Hygiene Products - FSA |
|
X requires LMN
|
|
Products used post-surgery or after childbirth may be reimbursed |
| Fertility Enhacement - FSA |
X
|
|
|
Includes fertility predictor kits and pregnancy tests |
| Fertility Treatments - FSA |
X
|
|
|
Examples include:
- Artificial insemination
- Egg donor and/or sperm donor for recipient
- Embryo replacement and storage (storage fees must not exceed 12 months)
- Embryo transfer
- Fertility exams
- FSH injections
- In vitro/ In vivo fertilization
- Sperm implants
|
| Fiber Supplements - FSA |
|
X requires LMN
|
|
Examples include:
|
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Finance Charges - FSA |
|
|
X
|
|
| First Aid Kits/Supplies - FSA |
X
|
|
|
|
| Fish Oil - FSA |
|
X requires LMN
|
|
Must be used to treat a specific medical condition or ailment such as High Cholesterol. If taking it for general health it is not eligible. |
| Flouride Rinse - FSA |
|
|
X
|
|
| Flu Shots - FSA |
X
|
|
|
|
| Food - FSA |
|
|
X
|
|
| Foot Care - FSA |
X
|
|
|
Examples include:
- Arch supports and insoles
- Bunion, blister and corn treatments
- Callous removers
|
| Funeral Expenses - FSA |
|
|
X
|
|
| Glucosamine - FSA |
X
|
|
|
|
| Guide Dogs - FSA |
X
|
|
|
|
| Gym Membership - FSA |
|
X requires LMN
|
|
Fees paid for a gym membership may be an eligible expense if prescribed by a physician and substantiated that treatment is necessary to alleviate a specific medical condition. YOU CANNOT BE REIMBURSED FOR EXPENSES THAT WILL BE INCURRED IN THE FUTURE |
| Hair Loss Treatment - FSA |
|
X requires LMN
|
|
If the hair loss was the result of an injury or trauma |
| Hair Transplant - FSA |
|
|
X
|
|
| Hand Sanitizer - FSA |
|
|
X
|
|
| Health Screenings - FSA |
X
|
|
|
|
| Hearing Aids - FSA |
X
|
|
|
|
| Heart Rate Monitors - FSA |
X
|
|
|
|
| Heating Pads - FSA |
X |
|
|
|
| Hemorrhoidal Treatments - FSA |
|
X requires RX
|
|
Examples include:
- Preparation H
- Tucks
- Tronolane
|
| Herbal Supplements - FSA |
|
X requires LMN
|
|
Examples include:
- Echinacea
- Gingko Biloba
- Valerian
- St. John's Wort
|
| Home Diagnostic Kits - FSA |
X
|
|
|
Examples include:
- Blood pressure monitors
- Pregnancy tests
- HIV tests
- Cholesterol tests
|
| Home Medical Equipment - FSA |
X
|
|
|
Potentially may need a LMN |
| Hypnosis - FSA |
X
|
|
|
|
| Immunizations - FSA |
X
|
|
|
|
| Incontinence Products - FSA |
X
|
|
|
Examples include:
|
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Insurance Premiums - FSA |
|
|
X
|
|
| In Vitro Fertilization - FSA |
X
|
|
|
|
| Kindergarten - DCA |
|
|
X |
Half and full day kindergarten are considered primarily educational. |
| Lab Fees - FSA |
X
|
|
|
|
| Lactation Consultant - FSA |
|
X
|
|
Services rendered by a licensed health care provider can be reimbursed. |
| Laser Eye Surgery - FSA |
X
|
|
|
|
| Laser Hair Removal - FSA |
|
|
X
|
|
| Latchkey - DCA |
X |
|
|
|
| Late Payment Fees - FSA & DCA |
|
|
X
|
|
| Late Pick Up Fees - DCA |
X
|
|
|
|
| Legal Fees - FSA |
|
X
|
|
Legal fees paid to authorize treatment for mental illness are eligible |
| Levitra - FSA |
X
|
|
|
|
| Lice Treatment - FSA |
|
X requires RX
|
|
Examples include:
|
| Lodging - FSA |
|
X
|
|
Up to $50 per night/per person is eligible if the following conditions are met:
- The lodging was primarily for, and essential to, medical care
- The medical care was provided by a doctor in a licensed hospital or medical care facility
- Expenses for food and beverage are not eligible
|
| Loding, for Companion - FSA |
|
X
|
|
If he or she is accompanying the patient ( you or your covered dependents) for medical reasons. |
| Long Term Care Insurance - FSA |
|
|
X
|
|
| Massage Therapy - FSA |
|
X requires LMN
|
|
If used to treat a specific medical condition or ailment. Reduce stress or improve general health is not eligible. |
| Maternity Clothes - FSA |
|
|
X
|
|
| Meals - FSA |
|
|
X
|
|
| Medical Alert Bracelet/Necklace - FSA |
X
|
|
|
|
| Medical Information/Records - FSA |
X
|
|
|
|
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Medicated Lip Products - FSA |
|
X requires RX
|
|
|
| Menstrual Relief - FSA |
|
X requires RX
|
|
|
| Migraine Relief - FSA |
|
X requires RX
|
|
|
| Mileage - FSA |
X
|
|
|
Effective 1/1/11 - 6/30/11, rate is 19 cents per mile
Effective 7/1/11, rate is 23.5 cents per mile
Must supply receipt that shows proof of the visit and the total mileage. Mileage for trips to the pharmacy are not eligible.
|
| Missed Appointment Fees - FSA |
|
|
X
|
|
| Motion Sickness Medicines - FSA |
|
X requires RX
|
|
|
| Mouthwash - FSA |
|
|
X |
|
| MRI - FSA |
X |
|
|
Patient portion after insurance pays |
| Nasal Spray - FSA |
|
X requires RX
|
|
|
| Nasal Strips - FSA |
X
|
|
|
Examples include:
|
| Nursery School - DCA |
X |
|
|
|
| Occupational Therapy - FSA |
X
|
|
|
|
| Optometrist - FSA |
X
|
|
|
|
| Oral Care - FSA |
|
|
X
|
|
| Orthodontia/Braces - FSA |
X
|
|
|
Download Reference Guide |
| Orthopedic Shoes - FSA |
|
X requires LMN
|
|
Only shoes custom fitted to the wearer's feet are eligible. Only the cost difference between the custom made shoe and a comparable shoe are eligible. Mass produced shoes are not eligible. |
| Orthotic Inserts - FSA |
X
|
|
|
|
| Osteopath - FSA |
X
|
|
|
|
| Over-the-counter drugs/medications - FSA |
|
X requires RX
|
|
Download OTC Reference Guide |
| Ovulation Monitor - FSA |
X
|
|
|
|
| Oxygen - FSA |
|
X
|
|
|
| Pain Relievers - FSA |
|
X requires RX
|
|
Examples include:
- Tylenol
- Motrin
- Advil
- Aleve
- Pamprin
- Ben Gay
- Icy Hot
- Midol
Download OTC Reference Guide
|
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Physical Therapy - FSA |
X
|
|
|
Examples include:
- Orthopedic therapy
- Rehabilitation
|
| Pre-Paid Fees - FSA & DCA |
|
|
X
|
The expense must be incurred before it is eligible |
| Pillows, Lumbar Support - FSA |
|
X requires LMN
|
|
Pillows or cushions that provide lumbar support may be eligible for reimbursement if prescribed by a licensed health care professional to treat or alleviate a specific medical condition
Download LMN
|
| Pre-kindergarten - DCA |
X |
|
|
|
| Pre-school - DCA |
X |
|
|
|
| Pregnancy Tests - FSA |
X
|
|
|
|
| Prescription Drugs - FSA |
X
|
|
|
|
| Prescription Drugs (imported) - FSA |
|
|
X
|
|
| Preventative Screenings - FSA |
X
|
|
|
|
| Prosthetics - FSA |
X
|
|
|
|
| Protection Plans - FSA |
|
|
X |
|
| Psychiatric Services and Care - FSA |
X
|
|
|
|
| Psychologists - FSA |
X
|
|
|
|
| Reading Glasses - FSA |
X
|
|
|
|
| Retin-A - FSA |
X
|
|
|
|
| Rogaine - FSA |
|
|
X
|
|
| Sales Tax - FSA |
X
|
|
|
|
| Shampoo - FSA |
|
|
X
|
|
| Shipping and Handling - FSA |
X
|
|
|
|
| Sleep Aids - FSA |
|
X requires RX
|
|
Examples include:
- Unisom
- Nytol
- Tylenol PM
- Sominex
Download OTC Reference Guide
|
| Smoking Cessation Products - FSA |
|
X requires RX
|
|
Examples include:
- Commit
- Nicoderm CQ
- Nicorette
- Nicotrol
|
| |
|
|
|
|
Condition/Type of Service
|
Eligible
|
Potentially Eligible
|
Not Eligible
|
Additional Information
|
| |
|
|
|
|
| Smoking Cessation Programs - FSA |
X
|
|
|
|
|
Speech Therapy - FSA
|
X
|
|
|
|
| Sterilization Procedures - FSA |
X
|
|
|
|
| Sterilization Reversal - FSA |
X
|
|
|
|
| Student Health Fee - FSA |
|
|
X
|
|
| Sunglass Clip-on - FSA |
|
|
X |
Sunglass clip-ons that go over eyeglasses are not eligible |
| Sunscreen - FSA |
X
|
|
|
SPF 30 or higher |
| Taxi Fare - FSA |
X
|
|
|
To and from medical appointments. Receipt of the visit required. |
| Teethwhitening - FSA |
|
|
X |
Considered as cosmetic procedure |
| Thermometers - FSA |
X |
|
|
|
| Toothbrushes - FSA |
|
|
X
|
|
| Tuition - FSA & DCA |
|
|
X |
Considered primarily as educational |
| Ultra Sound - FSA |
X
|
|
|
|
| Vaccinations - FSA |
X |
|
|
|
| Vasectomy - FSA |
X
|
|
|
|
| Vasectomy Reversal - FSA |
X
|
|
|
|
| Viagra - FSA |
X
|
|
|
|
| Vitamins - FSA |
|
X requires LMN
|
|
If used to treat a specific medical condition. Multi-vitamins used for general well-being are not eligible.
Download LMN
|
| Walkers - FSA |
X
|
|
|
|
| Warranties - FSA |
|
|
X
|
|
| Wart Removal - FSA |
|
X requires RX
|
|
Examples include:
|
| Weight Loss Programs - FSA |
|
X requires LMN
|
|
Food is not eligible. Programs such as Weight Watchers are eligible. Keep in mind pre-paid programs are not eligible. If your program requires full payment for a program that spans over multiple weeks, do not use your FSA to pay for it. Rather, pay for it out of pocket and when the program is successfully completed, submit your documentation along with a completed reimbursement form and letter of medical necessity for processing. |
|
Wheelchairs - FSA
|
X
|
|
|
|
