The eligibility of Medical Expenses will depend upon the type of benefit plan you in which you are enrolled:

Med-FSA – Generally speaking, your Medical Flex Spending Account (Med-FSA) will allow most if not all of the expenses listed below.

Limited Med-FSA – If you are a participant in the Health Savings Account (HSA), the Limited Purpose Med-FSA account is limited to dental, vision and preventive care expenses for you and your eligible dependents.

HRA – If your employer offers a Health Reimbursement Arrangement, the eligible expenses will be defined in your Summary Plan Description. Please contact your employer for more information.


Eligible Medical Expenses

Eligible Expenses

Generally speaking, most medical, dental and vision expenses are eligible and you can include the expenses of your eligible dependents, even if they are not covered under your employer’s group insurance plan. Eligible expenses are services and treatments that are medically necessary and prevent or treat illness or disease.

To be eligible, your expenses must be incurred — services actually received — by you or your eligible dependents during the plan year while you are/were an active participant and your claim for reimbursement of the eligible expenses must be submitted according to the requirements set by your employer’s plan.

The following is a partial list of eligible medical, dental and vision expenses:

Adaptive Equipment *
Allergy Products *
Ambulance Services
Artificial Limbs, Crutches, Canes & Wheelchairs
Birth Control & Contraceptives *
Breast Pump and Lactation Supplies
Childbirth Classes (Childbirth classes only. Does not include parenting, newborn/infant care and breastfeeding classes.)
Chiropractic Services
Christian Science Practitioner Fees
Co-payments, Coinsurance & Deductibles
Condoms
Cord Blood Storage (Rx required w/specific diagnosis.)
Counseling by a Licensed Provider (A medical diagnosis is required). Career and marriage counseling are not eligible.
CPAP & BiPAP Equipment and Supplies


Dental Services & Treatments

Bridges Cleanings Crowns
Dentures Fillings Implants
Root Canals Sealants X-Rays

Doula Services (Licensed Healthcare Provider only. Not for healthy baby/family postpartum care.)


Eye Care Services, Products & Treatments

Contact Lenses & Supplies Lasik Surgery
Prescription Glasses Rx Sunglasses
OTC Reading Glasses Vision Surgery

Fertility Enhancement

Artificial Insemination In Vitro Fertilization
Ovulation Monitors Pregnancy Tests
Temporary Egg/Sperm Storage (12 months or less) *

Guide and Disability Support Service Animals *
Gym Memberships & Fitness Programs * (New Gym and Fitness programs purchased at the direction of your physician to treat a specific medical condition. Prepaid memberships are eligible on a prorated basis month-by-month at the end of the month.)

Hearing Aids & Batteries
Immunizations/Flu Shots/Vaccinations
Insulin, Blood Sugar Testing Supplies & Equipment
Laboratory Fees
Lactation Consultant (Licensed Healthcare Provider only.)
Learning Disability Expenses *
Massage Therapy *
Medical Alert ID Bracelets/Necklaces
Medical Information Plans & Records Fees


Medical Service Provider Fees

Acupuncturists Chiropractors Dentists
Eye Doctors Oral Surgeons Orthodontists
Osteopaths Pediatricians Podiatrists
Physicians Psychiatrists Psychologists

Nursing Services (If medically necessary to provide or monitor medical treatment. Excludes postpartum care for healthy babies.)
Orthodontia Treatments
Orthopedic Shoes & Orthotic Devices *
Over-the-Counter Medications (Rx Required 1/1/2011)
Physical Therapy
Prescription Drugs
Prosthetics (Including Prosthetic Bras Post-mastectomy.)
Reconstructive Surgery
Smoking Cessation Treatments (Rx Required 1/1/2011)
Special Education, Testing, Tutoring and Schools *
Speech Therapy
Telephone Equipment for the Hearing Impaired
Transportation – Medical-related travel. The mileage reimbursement rate is $.17 per mile (was $.19 per mile for 2016) plus actual Parking and Toll Fees.  Claims for medical-related travel must be documented by the related medical expense documentation as well as a record of the miles traveled and the to/from information.  Mileage related to routine pharmacy trips are not eligible. Call us regarding any medical-related travel that involves travel by plane, train, bust or requires lodging or other travel expenses.
Ultrasound, Pre-natal (If medically necessary.)
Vasectomy & Vasectomy Reversal
Weight Loss Programs (Letter of Medical Necessity Required, no food or meal replacements.) *
Wig *


*A letter of medical necessity is required.

 

Special Expenses? Call Us! There are other expenses that may eligible and some that will require a prescription and special documentation. If you have an unusual situation or if your expense is not listed above, please contact us for more information at 1-800-995-5373.

2011 OTC MEDICATION CHANGE:

The Patient Protection and Affordable Care Act (PPACA) changed the eligibility of Over-The-Counter Medications (OTC). Effective January 1, 2011, OTC medications are only eligible if prescribed by a physician* and that prescription must accompany your claims for reimbursement. This means that you will need a prescription from your Physician or Nurse Practitioner to be reimbursed for OTC Medications from your Med-FSA or HRA. This law is new and the guidance and interpretations is not complete. For the most current information on eligible OTC medications, including the prescription requirements, please click here.

Over-The-Counter Medications

(Rx required for reimbursement of purchases made on or after 1/1/2011)

Category The following are examples of OTC medications that are eligible in the Med-FSA:
Allergy, Asthma & Cold Medicines Actifed®, Afrin®, Benadryl®, Bronkaid®, Cepacol®, Chloraseptic®, Claritin®, Drixoral®, Hall’s Cough Drops®, Nasal Crom®, Neo-Synephrine®, NyQuil®, PediaCare®, Primatene Mist®, Robitussin®, Sine-Aid®, Sucrets®, Sudafed®, TheraFlu®, Triaminic®, Vicks®
Anesthetics Anbesol®, Num-Zit®, Orajel®, Rid-A-Pain®, Cough Drops, Topicaine®, Unguentine®
Antifungals Cruex®, Fem-Stat3®, Gyne-Lotrimin®, Lamisil®, Monistat®, Tinactin®, Vagistat®
Aspirin & Pain Relief Advil®, Aleve®, Ascriptin®, Azo®, Bayer®, Bufferin®, Doan’s®, Ecotrin®, Excedrin®, Midol®, Motrin®, Nuprin®, Pamprin®, Tylenol®, St. Joseph®, Vanquish®
Smoking Cessation Commit®, Endit®, NicoBloc®, Nicoderm®, Nicorette®, Nicotrol®
Stomach & Intestinal Alka-Seltzer®, Beano®, Citrucel®, Ex-Lax®, Gas-X®, Imodium®, Kaopectate®, Lactaid®, Maalox®, Metamucil®, Milk of Magnesia®, Mylicon®, Pepcid®, Pepto-Bismol®, Prilosec®, Rolaids®, Tagamet®, Tums®, Zantac®
Topical Treatments Abreva®, Antibiotics, Aspercreme®, Bactine®, Betadine®, Capcaicin®, Cortizone®, Desitin®, Herpecin®, Fleet Relief®, Mentholatum®, Neosporin®, Preparation H®, Sportscreme®

Eligible Over-The-Counter Medical Products

(No Prescription Required)

  • Anti-arthritics Supplements (Glucosamine and Chrondroitin)
  • Band-Aids® & Bandages
  • Bathtub Rails/Grips
  • Blood Pressure Monitors
  • Braces & Supports
  • Breast Pumps & Supplies
  • Canes & Crutches
  • Compression Hosiery/Socks*
  • Condoms
  • Contact Lens Solutions
  • CPAP Supplies

  • Denture Care Products Diabetic Supplies
  • Drug & Diagnostic Test Kits
  • Eye Glass Cleaning Supplies
  • Fertility Monitor
  • First Aid Kits
  • Heart Rate Monitor (non-sports)
  • Hearing Aid Batteries
  • Home Medical Test Kits
  • Ice or Heat Pads/Packs
  • Incontinence Products
  • Maternity Belts & Hose*

  • Middle Ear Monitor
  • Nasal/Sinus Rinse Supplies
  • Nebulizers & Inhalers
  • Orthotic Shoe Inserts
  • Ovulation Test Kits
  • Pregnancy Test Kits
  • Prenatal Vitamins
  • Reading Glasses
  • Sunscreen (SPF 15+)**
  • Surgical Stockings
  • Thermometers
  • Walkers & Wheelchairs

*Medical-grade products only.

** Does not include lotions or other products that contain sunscreen or SPF protection.

The use of categories, trademarks and brand names is solely for your reference and does not indicate or imply endorsement, recommendation or limitation.
Quantities in a single purchase or a series of purchases are limited to a 90-day supply or the equivalent of a 90-day supply.

 

What Expenses Are Not Eligible?

Generally, expenses are not eligible if you don’t owe the provider, or if the expenses are cosmetic in nature or not medically necessary. For example:

  • Cosmetic services and products such as Botox®, Breast Augmentation, Propecia®, Rogaine® & teeth whitening.
  • Foods & food replacements are not eligible unless the food does not satisfy normal nutritional needs and is prescribed to treat a specific medical condition as prescribed by a physician. Then the special food cost would be eligible to the extent that the cost of the special food exceeds the cost of a normal diet.
  • Life Coaching, Career Counseling, Family, Marriage and/or Parental Counseling are not eligible unless it is primarily for medical care to treat a specific medical condition or diagnosis.
  • Medications and services that are not legal and eligible per the FDA/Federal Law, regardless of their status under State Laws.
  • Missed appointment fees, late fees and finance charges.
  • Personal use items are not eligible. This includes such expenses as clothing, earplugs, personal or feminine hygiene products, infant diapers, soaps, sunglasses (non-Rx), etc. In some cases, the excess cost of a special form may be eligible.*
  • Preferred Provider (PPO) discounts are not eligible.
  • Prepaid medical fees such as “concierge,” “boutique,” and similar membership and retainer fees paid on a monthly, quarterly or annual basis are not eligible.
  • Premiums, Insurance & Student Health fees.
  • Prescription Drugs imported to U.S. from foreign countries are not generally eligible.
  • Prior balance and balance forward statements do not provide sufficient documentation.
  • Toothbrushes and toothpaste are not eligible, even if prescribed to treat a specific medical/dental condition.
  • Vitamins, herbs, biologicals, botanicals, homeopathic medications & food supplements are not eligible unless prescribed by a physician (M.D. or D.O.) to treat a specific medical condition.*

*Letter of Medical Necessity Required. A prescription or letter of medical necessity is required from your physician including the specific medical diagnosis and treatment plan.

  • The term “physician” refers to an individual licensed and authorized to write prescriptions for medications in the state in which services were provided..  This includes Doctors (M.D., N.D., or D.O.) and may include Physician’s Assistants and Nurse Practitioners (N.P.).
  • The prescription or letter of medical necessity must be dated and signed (valid for one year) and include the name of the patient, the recommendation and a specific medical diagnosis.
  • Stress relief, general health and preventive care are not sufficient for a diagnosis.
  • If prescribed by a physician to treat a specific medical condition, the excess cost of a special form may be eligible for personal use items that are used in daily life, such as shoes, clothing and allergen-free bedding.
  • Gym memberships may be eligible if purchased subsequent to the recommendation of your physician to treat a specific medical condition.
  • Vitamins, biological, botanical, herbal and homeopathic remedies recommended by a health professional, such as a Chiropractor or Acupuncturist, to treat a medical condition as diagnosed by a physician, will require documentation of the diagnosis from the physician and the letter of medical necessity from the health professional.

This brochure is not intended to provide tax or legal advice. Please contact your personal advisor regarding your personal situation. This is a brief introduction to these benefits. Please read the Summary Plan Description (SPD) that your employer gave you. The SPD is a detailed description of your  Plan and includes important information regarding the benefits, the eligibility requirements and the claims filing deadlines.