FSA Eligible Expenses.doc.doc


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FSA Eligible Expenses.doc.doc

  1. 1. FSA, HRA, HSA: Eligibleand Ineligible Expenses"Medical care" expenses as defined by Section 213(d) includeamounts paid for the diagnosis, treatment, or prevention ofdisease, and for treatments affecting any part or function of thebody. The expenses must be to alleviate or prevent a physicaldefect or illness. Expenses for solely cosmetic reasons generallyare not expenses for medical care. Examples include face lifts,hair transplants, and hair removal (electrolysis). Also, expensesthat are merely beneficial to ones general health (for example,vacations) are not expenses for medical care.Alphabetical List of Covered and Not Covered ItemsA-DAbortion - Medical expenses associated with a legal abortionare reimbursable.Acne laser treatment - Expenses paid for acne treatment arecovered.Acupuncture - Medical expenses paid for acupuncture arereimbursable.Adult diapers - Expenses paid for diapers are reimbursable.After-sun gel/lotions with aloe - Expenses for medicated gelsand locations to treat effects of sun exposure are covered.Airplane air contaminant protection - Expenses paid forover-the-counter medications to prevent the spread of airbornecontaminants while flying are reimbursable.Alcoholism and drug abuse - Medical expenses paid to atreatment center for alcohol or drug abuse are reimbursable.This includes meals and lodging provided by the center duringtreatment.Alternative providers - Expenses paid to alternative providersfor homeopathic or holistic treatments or procedures aregenerally not covered unless to treat a specific medicalcondition. Naturopathic procedures or treatments using naturalagents such as air, water or sunshine are generally notreimbursable. Members explanation of necessity required.Ambulance - Medical expenses paid for ambulance service arereimbursable.Artificial limb - Medical expenses paid for an artificial limbare reimbursable.Artificial teeth - See Medical aids.
  2. 2. Attendant - See Nursing services.Automobile - See Car.Back brace - Expenses paid for a back brace are reimbursablewhen submitted with a members explanation of necessity.Batteries - Expenses paid for the purchase of batteries arereimbursable when they are used for the sole purpose of an itemthat is also covered. This would include, but not be limited to,batteries for blood pressure machines, wheelchairs, heartdefibrilaters, etc. Request for reimbursement should include adescription of the item the batteries are purchased for.Benefit maximum - Expenses denied by medical insurance asbenefit maximum(s) have been exhausted are reimbursable.Birth control pills and devices - Medical expenses paid forbirth control pills, injections and devices are reimbursable.Birthing tub - The cost of rental or purchase is reimbursable.Blood pressure monitor - Expenses paid for the purchase ofthe monitor are reimbursable.Braille books and magazines - The amount by which the costof Braille books and magazines for use by a visually impairedperson exceeds the price for regular books and magazines isreimbursable.Breast augmentation - Expenses related to breastaugmentation (such as implants or injections) are notreimbursable because the procedure is cosmetic in nature.However, medical costs related to the removal of breastimplants that are defective or are causing a medical problem arereimbursable.Breast reduction - Medical expenses related to breastreduction surgery are reimbursable only with a physiciansdiagnosis letter explaining that the procedure is medicallyrequired and not for cosmetic purposes (that is, to prevent ortreat an illness or disease).Breathing strips - Expenses paid for the purchase of the stripsare reimbursable.Capital expenses - If their main purpose is medical care capitalexpenses paid for special equipment installed in a participantshome or for improvements to the home are reimbursable.Car - Medical expenses are reimbursable for special handcontrols and other special equipment installed in a car for theuse of a person with disabilities. Also, the amount by which thecost of a car specially designed to hold a wheelchair exceedsthe cost of a regular car is a reimbursable medical expense.However, the cost of operating a specially-equipped car is notreimbursable. See Transportation.Chair - The cost of a reclining chair purchased on the advice ofa physician to alleviate a heart, back or other condition is
  3. 3. reimbursable.Child care - See Dependent day care expenses.Childbirth classes - Expenses for childbirth classes arereimbursable, but are limited to expenses incurred by themother-to-be. Expenses incurred by a "coach"- even if that isthe father-to-be - are not reimbursable. To qualify as medicalcare, the classes must address specific medical issues, such aslabor, delivery procedures, breathing techniques and nursing.Chiropractor - Expenses paid to a chiropractor for medicalcare are reimbursable.Christian Science practitioners - Medical expenses paid toChristian Science practitioners are reimbursable.Clinic - Medical expenses for treatment at a health clinic arereimbursable.COBRA premiums - COBRA premiums that you pay foryourself or your eligible dependents are not reimbursable undera Health FSA. However, COBRA premiums are reimbursableunder an HRA or HSA.Coinsurance amounts - Medical coinsurance amounts anddeductibles are reimbursable.Compound medications - Medications produced by medicalprofessionals to treat a medical condition are reimbursable.Contact lenses - See Vision care.Copies of medical records or radiographs - Paymentsrequired to have medical records or radiographs duplicated arereimbursable.Corn pads - Expenses paid for the purchase of corn pads arereimbursable.Cosmetic surgery - Medical expenses for cosmetic surgery arereimbursable only if the surgery is necessary to improve adeformity arising from, or directly related to, a congenitalabnormality, a personal injury resulting from an accident ortrauma, or a disfiguring disease. However, medical expensespaid for other cosmetic surgery are not deductible medicalexpenses under Code Section 213(d), and thus are notreimbursable. This applies to any procedure that is directed atimproving the patients appearance and does not meaningfullypromote the proper function of the body or prevent or treatillness or disease. For example, face lifts, hair transplants, hairremoval (electrolysis), liposuction and teeth bleaching aregenerally not deductible. If there is a concern that a medical ordental surgery could be considered cosmetic, a physiciansdiagnosis letter is required.CPR classes - Expenses paid for CPR classes as part ofbirthing classes are reimbursable, otherwise a physiciansdiagnosis letter for the family member is required.
  4. 4. Crutches - Medical expenses paid to buy or rent crutches arereimbursable.Dancing lessons, swimming lessons, etc. - Dancing swimminglessons, etc., are not reimbursable, even if they arerecommended by a doctor.Day-after pill - Expenses paid for the purchase of pills toeliminate pregnancy risk are reimbursable.Day care - See Dependent day care expenses.Deductibles - Medical insurance deductibles and coinsuranceamounts under the employers plan are reimbursable.Dental treatment - Medical expenses for dental treatment arereimbursable. This includes fees paid to dentists for X-rays,models and molds, fillings, braces, extractions, dentures, dentalimplants, veneers and the difference in cost from insurance-approved restorations and alternative materials, etc. SeeCosmetic surgery.Dependent day care expenses - Dependent day care expensesare not reimbursable under a Health FSA, HRA or HSA, butmay be reimbursable under a dependent care FSA.Diaper service - Payments for diapers or diaper services arenot reimbursable unless they are needed to relieve the effects ofa particular disease.Diets - See Special foods.Donor egg extraction - Procedural expenses paid for theprocess of donor egg extraction to treat infertility arereimbursable.Doula - Expenses paid for a doula whos primary purpose is fordelivery of the infant are reimbursable. Charges where theprimary purpose is child care after delivery are not covered. Anexplanation of the primary purpose should accompany theclaim.Drugs - See Medicines.Drug addiction - See Alcoholism and drug abuse.Dry cast, protectors - Expenses paid for the purchase of drycasts and bandage protectors are reimbursable. Back to topE-LEar molds - Expenses paid for the purchase of ear molds arereimbursable.Ear piercing - Expenses for ear piercing are not reimbursable.Ear wax removal - Expenses paid for the purchase of ear waxremoval kits are reimbursable.Electric toothbrush - Expenses paid for the purchase of
  5. 5. electric toothbrushes are reimbursable when submitted with aphysicians diagnosis letter.Electrolysis or hair removal - See Cosmetic surgery.Embryo storage - Expenses paid for embryo storage arereimbursable.Employment-related expenses - Employment-relatedexpenses such as employment physicals are not reimbursable.(Note, however, that physical exams that are not employment-related are reimbursable.) See Physical exams.Employment taxes - See Nursing services.Exercise equipment - The cost of exercise equipment forgeneral well-being is not reimbursable. If the equipment isprescribed by a physician to treat specific medical conditions(e.g. diabetes), then the expense should be reimbursable.Physicians diagnosis letter is required.Eyeglasses - See Vision care.Fitness programs - Fitness programs or physical therapy forgeneral health are not reimbursable.Fluoride, prescribed - Expenses paid for fluoride toothpaste orrinses prescribed to treat a specific medical condition arecovered. Physicians diagnosis letter required.Food - See Special foods.Funeral expenses - Expenses for funerals are not reimbursable.Genesis - Expenses paid for genesis to treat conditions such asrosacea are reimbursable.Gift cards - Gift cards can be used to purchase items and thereceipts for those items can then be submitted forreimbursement.Gloves, latex - Expenses paid for latex gloves are reimbursable.Group medical insurance - See Insurance premiums.Guide dog or other animal - The cost of a guide dog or otheranimal used by the visually impaired or hearing impaired isreimbursable. Costs associated with a dog or other animaltrained to assist persons with other physical disabilities are alsoreimbursable, as are amounts paid for the care of thesespecially-trained animals.Hair transplant - See Cosmetic surgery.Hand sanitizer - Expenses paid for hand sanitizers arereimbursable.Health club dues - Health club dues, YMCA® dues, oramounts paid for steam baths for general health or to relievephysical or mental discomfort not related to a particular medicalcondition are not reimbursable.Hearing aids - Medical expenses for a hearing aid, repairs and
  6. 6. batteries are reimbursable. Heart defibrillator - Expenses paidfor heart defibrillators are reimbursable.Herbs - The cost of herbs taken for general well-being are notreimbursable. However, the cost of herbs taken to alleviate aspecific medical condition are reimbursable. Physiciansdiagnosis letter required.Holistic treatments - See Alternative providers.Home urine test kit - Expenses paid for home urine test kitsare reimbursable. See Kits.Homeopathic treatments - See Alternative providers.Hospital - Expenses incurred as a hospital in-patient or out-patient for laboratory, surgical and diagnostic services qualifyas medical expenses. Hot pads, creams and patches - Expensespaid for hot pads, creams and patches are reimbursable.Hot tub - See Capital expenses.Household help - The cost of household help, even ifrecommended by a doctor, is prohibited. However, certainexpenses paid to an attendant providing nursing-type servicesare reimbursable. See Nursing services.Human guide - Expenses for a human guide - to take a blindchild to school, for example - are reimbursable. See Guide dogor other animal.Hypnotherapy - Expenses paid for hypnotherapy arereimbursable when prescribed by a physician as therapy to treata medical condition. Physicians diagnosis letter required.Impotence or sexual inadequacy - Medical expenses relatedto the treatment of impotence are reimbursable. Physiciansdiagnosis letter required.Infertility - Medical expenses related to the treatment ofinfertility are reimbursable. Eligible expenses may include eggstorage, egg donor costs, infertility monitors, in-vitrofertilization and sperm washing. Surrogate costs associated witha qualified dependent of the taxpayer are reimbursable and mayinclude such things as blood compatibility testing andpsychological exams. If the surrogate mother is not a qualifieddependent of the taxpayer, the costs that the surrogate motherincurs are not reimbursable. Storage costs associated with thefreezing of blood cords, embryos, placentas and sperm (spermbanks) are generally reimbursable when a specific medicalcondition exists. Additionally, these costs are reimbursable onlyfor a limited period until they can be used to treat the existingcondition (generally up to one year). Physicians diagnosisletter required.Insoles - Expenses paid for insoles to treat a medical conditionare reimbursable. Members explanation of necessityrequired.
  7. 7. Insulin - The cost of insulin is reimbursable.Insurance premiums - Premiums for any health plan are notreimbursable under a Health FSA. However, see exceptions forHRA and HSA.Kits - Expenses paid for kits such as first aid, home test, snakebite and bee sting are reimbursable.Laboratory fees - Laboratory fees that are part of medical careare reimbursable.Lasik eye surgery - Radial keratotomy (RK), or othercorrective eye surgery such as lasik surgery is a deductibleexpense under IRC Section 213(d) and is reimbursable.Lead-based paint removal - The cost of removing lead-basedpaints from surfaces in a home to prevent a child who has (orhas had) lead poisoning from eating the paint are reimbursable.These surfaces must be in poor repair (peeling or cracking) orwithin the childs reach. The cost of repainting the scraped area,however, is not reimbursable.Learning disability - Tuition payments to a special school fora child who has severe learning disabilities caused by mental orphysical impairments, including nervous system disorders, arereimbursable. A doctor must recommend that the child attendthe school. Also, tutoring fees paid on a doctorsrecommendation for a childs tutoring by a teacher who isspecially trained and qualified to work with children who havesevere learning disabilities are reimbursable. See Schools,special.Legal fees - Legal fees paid to authorize treatment for mentalillness are reimbursable. However, any part of a legal fee that isa management fee, for example, a guardianship or estatemanagement fee, is not reimbursable.Licensing requirements - Neither the tax code nor IRSregulations require a plan participant to determine whether aprovider is qualified, authorized under state law or licensed topractice before using his/her services. Services provided by arange of organizations and individuals may be reimbursable,including care provided by hospitals, medical doctors, dentists,eye doctors, chiropractors, nurses, osteopaths, podiatrists,psychiatrists, psychologists, physical therapists, acupuncturists,psychoanalysts and others.Life insurance premiums - Life insurance premiums are notreimbursable.Lifestyle drugs - Expenses paid for lifestyle drugs such asimpotence, are reimbursable when accompanied by aphysicians diagnosis letter.Lip treatments - Expenses paid for lip treatments to treat amedical condition such as cold or canker sores are
  8. 8. reimbursable.Liposuction - See Cosmetic surgery.Lodging and meals - The cost of lodging and meals at ahospital or similar institution are reimbursable if the employeesmain reason for being there is to receive medical care. The costof lodging not provided in a hospital or similar institution whilean employee is away from home is reimbursable if fourrequirements are met: (1) the lodging is primarily for andessential to medical care; (2) medical care is provided by adoctor in a licensed hospital or in a medical care facility relatedto, or the equivalent of, a licensed hospital; (3) the lodging isnot lavish or extravagant under the circumstances; and (4) thereis no significant element of personal pleasure, recreation orvacation in the travel away from home. See Nursing home.The reimbursable amount cannot exceed $50 for each night foreach person. Lodging is included for a person for whomtransportation expenses are a medical expense because thatperson is traveling with the person receiving the medical care.For example, if a parent is traveling with a sick child, up to$100 per night is reimbursable as a medical expense forlodging. Meals and lodging away from home for medicaltreatment that is not received at a medical facility, or for therelief of a specific condition, are not reimbursable even if thetrip is made on the advice of a doctor.Long-term care insurance premiums - Long-term careinsurance premiums are not reimbursable under a Health FSA.However, see exceptions for HRA and HSA. Back to topM-OMaintenance costs - Portion of expense incurred to maintainequipment used to treat a medical condition are reimbursable.For example, the cost of electricity to operate an air purifierwhen suffering from asthma. Members explanation ofnecessity required.Marriage counseling - Expenses for marriage counselingservices do not qualify as medical expenses. However, sexualinadequacy or incompatibility treatment is reimbursable if thetreatment is provided by a psychiatrist.Massage - Fees paid for massages are not reimbursable unlessto treat a physical defect or illness. Physicians diagnosis letter
  9. 9. required. See TherapyMassage chair - Expenses paid for a massage chair to treat amedical condition are reimbursable. Physicians diagnosisletter required.Maternity clothes - Expenses for maternity clothes are notreimbursable.Maternity support - Expenses paid for a maternity supportband are reimbursable.Mattresses - Mattresses and mattress boards for the treatmentof arthritis are reimbursable.Meals - See Lodging and meals, or Special foods.Medical aids - Medical aids such as false teeth, hearing aids,orthopedic shoes, crutches and elastic hosiery are reimbursable.Medical alert programs - Expenses incurred to enroll in amedical alert program are reimbursable when accompanied by aphysicians diagnosis letter.Medical information plan - Amounts paid to a plan that keepsmedical information so that it can be retrieved from a computerdata bank for medical care are reimbursable.Medical services - Only legal medical services arereimbursable. Amounts paid for illegal operations or treatments,regardless of whether they are rendered by licensed orunlicensed practitioners, are not reimbursable.Medicare Part A - The premium paid for Medicare Part A isnot reimbursable under a Health FSA. However, see exceptionsfor HRA and HSA.Medicare Part B - Premiums paid for Medicare Part B are notreimbursable under a Health FSA. However, see exceptions forHRA and HSA.Medicated soaps, powders and shampoos - Expenses paid forover-the-counter items that are medicated to treat a medicalcondition are reimbursable.Medicines - Amounts paid for prescribed medicines and drugsare reimbursable. A prescribed drug is one which requires aprescription by a doctor for its use by an individual. The cost ofinsulin is also reimbursable. The cost of a prescribed drugbrought in (or ordered and shipped) from another countrycannot be reimbursed. The importation of prescribed drugs byindividuals is illegal under federal law (even if allowed by statelaw). However, you can be reimbursed for the cost of aprescribed drug that you purchased and consumed in anothercountry if the drug is legal in both the other country and theUnited States. See Over-the-counter medicines and drugs.Mentally retarded, special home for - The cost of keeping amentally retarded person in a special home (not the home of a
  10. 10. relative) on the recommendation of a psychiatrist to help theperson adjust from life in a mental hospital to community livingis reimbursable.Naturopathic treatments - See Alternative providers.Nausea relief - Expenses paid for nausea relief such as nauseabands are reimbursable.Nursing home - The cost of medical care in a nursing home orhome for the aged for an employee, or for an employees spouseor dependent, is reimbursable. This includes the cost of mealsand lodging in the home if the main reason for being there is toget medical care.Nursing services - Wages and other amounts paid for nursingservices are reimbursable. Services need not be performed by anurse as long as the services are of a kind generally performedby a nurse. This includes services connected with caring for thepatients condition, such as giving medication or changingdressings, as well as bathing and grooming the patient.Only the amount spent for nursing services is reimbursable. Ifthe attendant also provides personal and household services,these amounts must be divided between the time spentperforming household and personal services and the time spenton nursing services.Meals - Amounts paid for an attendants meals are alsoreimbursable. This cost may be calculated by dividing ahouseholds total food expenses by the number of householdmembers to find the cost of the attendants food, thenapportioning that cost in the same manner used for apportioningan attendants wages between nursing services and all otherservices. (See above)Upkeep - Additional amounts paid for household upkeepbecause of an attendant are also reimbursable. This includesextra rent or utilities paid because of having to move to a largerapartment to provide space for an attendant.Infant care - Nursing or baby sitting services for a normal,healthy infant are not reimbursable.Social Security, unemployment (FUTA) and Medicare taxespaid for a nurse, attendant or other person who providesmedical care are reimbursable.Optometrist - See Vision care.Oral syringe - Expenses paid for an oral syringe used todispense medication are reimbursable.Orthodontia - Services are reimbursable. This type of servicedoes not fit the normal fee for service arrangements seen withother care, and reimbursement can be made once charges havebeen billed. This can be a one time fee less any amount paid, orto be paid by your insurance plan, or as you are billed each
  11. 11. month.Orthodontia wax - Expenses paid for orthodontia wax arereimbursable.Orthopedic shoes - See Medical aids.Organ donor - See Transplants.Over-the-counter medicines and drugs - Expenses aregenerally reimbursable unless used for general well-being or forpurely cosmetic purposes. Eligible expenses may include, butare not limited to acetaminophen, acne products, allergyproducts, antacid remedies, antibiotic creams/ointments, anti-fungal foot sprays/creams, aspirin, baby care products, coldremedies, (including shower vapor tabs and vapor units), coughsyrups and drops, contraceptive and family planning items, eyedrops and contact lens solutions, ear drops, ibuprofen, laxatives,migraine remedies, nasal sprays, pain relievers, peroxide andrubbing alcohol, sleep aids, and topical creams for itching,stinging, burning, pain relief, sore healing or insect bites. SeeKits and Vapor units and refills.Over-the-counter supplies - Expenses paid for bandages,ACE® wraps, hot pads, Q-tips®, cotton balls, first aid kits,gauze bandages, home test kits (e.g. diabetic, pregnancy), andsnake bite and bee sting kits are reimbursable. See Kits.Oxygen - Amounts paid for oxygen or oxygen equipment torelieve breathing problems caused by a medical condition arereimbursable. Back to topP-SParental assistance - Expenses incurred with an agency toassist parents with newborn care (which may include nurturingare not covered unless prescribed by a physician for a medicalcondition.Parking - See Transportation.Personal use items - Items that are ordinarily used forpersonal, living, and family purposes are not reimbursableunless they are used primarily to prevent or alleviate a physicalor mental defect or illness. For example, the cost of a wigpurchased at the advice of a physician for the mental health of apatient who has lost all of his or her hair from disease isreimbursable.If an item purchased in a special form primarily to alleviate aphysical defect is one that in normal form is ordinarily used forpersonal, living and family purposes, the cost of the special
  12. 12. form in excess of the cost of the normal form is reimbursable.See Braille books and magazines.Phone equipment - See Telephone.Physical exams - Physical exams are generally reimbursable,except for employment-related physicals. See Employment-related Expenses.Pill cutter - Expenses paid for the purchase of a pill cutter arereimbursable.Pillows for treatment of fevers - Expenses paid for thepurchase of pillows manufactured specifically to treat fevers arereimbursable.Plane tickets - Expenses paid for the purchase of a plane ticketfor a related hospitalization are reimbursable. SeeTransportation.Potty pager - Expenses paid for the purchase of a potty pagerare reimbursable.Pre-existing conditions - Medical expenses not coveredbecause of the plans pre-existing condition limitation arereimbursable.Premiums - Premiums, of any kind, that you pay for yourselfor your eligible dependents are not reimbursable under a HealthFSA. However, see exceptions for HRA and HSA.Prescription drugs - See Medicines.Private hospital room - The extra cost of a private hospitalroom is reimbursable.Propecia® - Reimbursable when prescribed by a physician fora specific medical condition, but not for cosmetic purposes (thatis, to stimulate hair growth). Physicians diagnosis letterrequired.Prosthesis - See Artificial limb.Psychiatric care - Expenses for psychiatric care arereimbursable. These expenses include the cost of supporting amentally ill dependent at a specially-equipped medical centerwhere the dependent receives medical care. See Psychoanalysisand Transportation.Psychoanalysis - Expenses for psychoanalysis arereimbursable.Psychologist - Expenses for psychological care arereimbursable.Radial keratotomy - Radial keratotomy (RK), or othercorrective eye surgery such as lasik surgery, is a deductibleexpense under IRC Section 213(d) and is reimbursable.Radon remediation - Expenses incurred to remove radon fromthe residence are reimbursable.Reasonable and customary charges, amounts in excess of -Medical expenses in excess of the plans reasonable and
  13. 13. customary charges are reimbursable.Rebundled charges - Charges for services that are rebundledby the medical insurance plan for which the provider does notparticipate are reimbursable.Resort - See Spa or resort.Retin-A - Expenses are reimbursable when prescribed by aphysician for treatment of acne, but not aging. Physiciansdiagnosis letter required.Rogaine® - Reimbursable when prescribed by a physician for aspecific medical condition, but not for cosmetic purposes (thatis, to stimulate hair growth). Physicians diagnosis letterrequired.Sales tax - Sales tax charges incurred when paying for aneligible expense are reimbursable.Scar treatments - Expenses incurred for the treatment of scarsare reimbursable.Schools, special - Expenses paid to a special school for amentally impaired or physically disabled person arereimbursable if the main reason for using the school is itsresources for treating the disability. This includes the cost of aschool that: • teaches Braille to a visually impaired child; • teaches lip-reading to a hearing-impaired child; or • provides remedial language training to correct a condition caused by a birth defect.The cost of meals, lodging and ordinary education supplied by aspecial school is reimbursable only if the main reason for usingthe school is its resources for treating the mental or physicaldisability. The cost of sending a non-disabled "problem child"to a special school for benefits the child may get from thecourse of study and disciplinary methods is not reimbursable.Scientology "audits" - Amounts paid to the Church ofScientology for "audits" do not qualify as expenses for medicalcare.Sexual counseling - Expenses for counseling regarding sexualinadequacy or incompatibility are reimbursable if thecounseling is provided to a husband and/or wife by apsychiatrist.Shampoo, medicated - Expenses paid for the purchase ofmedicated shampoos used to treat a scalp condition arereimbursable.Shipping charges - Shipping charges incurred when paying foran eligible expense are reimbursable.
  14. 14. Shower chair - Expenses incurred for the purchase of a showerchair are reimbursable when accompanied by a physiciansdiagnosis letter.Smoking drugs - The cost of drugs to stop smoking for theimprovement of general health are reimbursable.Smoking program - The cost of a program to stop smoking forthe improvement of general health is reimbursable.Spa or resort - Although a visit to a spa or resort may beprescribed by a physician for medical treatment, only the costsof the medical services provided are reimbursable, not the costof transportation. See Transportation and Trips.Special foods - The costs of special foods and/or beverages -even if prescribed - that substitute for other foods or beverageswhich a person would normally consume and which satisfynutritional requirements (such as the consumption of bananasfor potassium), are not deductible. However, prescribed specialfoods or beverages are reimbursable if they are consumedprimarily to alleviate or treat an illness or disease, and not fornutritional purposes. Special foods and beverages arereimbursable only to the extent that their cost is greater than thecost of the commonly available version of the same product.Claim submission should include the normal cost of the item.Sperm storage - Expenses incurred for sperm storage arereimbursable.Sports mouthguard - Expenses incurred for the purchase of asports mouthguard are reimbursable.Sports orthotics - Expenses paid for sports orthotics arereimbursable when submitted with a physicians diagnosisletter.Sterilization - The cost of a legal sterilization (a legally-performed operation to make a person unable to have children)is reimbursable.Stethoscope - Expenses incurred for the purchase of astethoscope are reimbursable.Substance abuse - See Alcoholism and drug abuse.Sunscreen - Expenses incurred for the purchase of sunscreenare reimbursable.Supplements - The cost of supplements taken for general well-being are not reimbursable. However, the cost of supplementstaken to alleviate a specific medical condition is reimbursable.Physicians diagnosis letter required.Swimming lessons - See Dancing lessons, swimming lessons,etc. Back to top
  15. 15. T-ZTaxes, state care or sick tax - Tax amounts passed on to themember are reimbursable.Telephone - The costs of purchasing and repairing specialtelephone equipment that lets a hearing-impaired personcommunicate over a regular telephone are reimbursable.Television - The cost of equipment that displays the audio partof TV programs as subtitles for the hearing-impaired isreimbursable. This may include an adapter that attaches to aregular TV or the cost of a specially-equipped TV in excess ofthe cost of the same model regular TV set.Therapy - Amounts paid for Therapy received as medicaltreatment are reimbursable. Payments made to an individual forspecial exercises or music therapy administered to a mentallyretarded child are also reimbursable. These so-called"patterning" exercises consist mainly of coordinated physicalmanipulation of the childs arms and legs to imitate crawlingand other normal movements. See Fitness programs orMassage.Thermometer - Expenses for purchase of a thermometer orthermometer covers are reimbursable.Toilet seat covers - Expenses incurred for the purchase of toiletseat covers are reimbursable.Transplants - Payments for surgical, hospital, laboratory andtransportation expenses for a prospective or actual donor of akidney or other organ are reimbursable.Transportation - Amounts paid for transportation primarilyfor, and essential to, medical care are reimbursable.Reimbursable transportation expenses include: • bus, taxi, train or plane fare, or ambulance service; • actual car expenses, such as gas and oil (but not expenses for general repair, maintenance, depreciation and insurance); • mileage charges from the service provider related to rendering care and patient observation for treatment plan development; • parking fees and tolls; • transportation expenses of a parent who must accompany a covered member who needs medical care; • transportation expenses of a nurse or other person who can give injections, medications or other treatment required by a patient who is traveling to get medical
  16. 16. care and is unable to travel alone; • transportation expenses for regular visits to see a mentally ill dependent if these visits are recommended as a part of treatment.Instead of actual expenses, it is acceptable to use a flat rate permile for each mile a car is used for medical purposes. The IRSupdates this amount annually, refer to IRS publications forcurrent reimbursable rate. The cost of tolls and parking may beadded to this amount.Reimbursable transportation expenses do not include: • transportation expenses to and from work, even if a medical condition requires an unusual means of transportation; or • transportation expenses incurred if, for non-medical reasons, an employee chooses to travel to another location (or to a resort or spa) for an operation or other medical care prescribed by a doctor.Trips - Amounts paid for transportation to another location, ifthe trip is primarily for and essential to receiving medicalservices, are reimbursable. See Lodging and meals.A trip or vacation taken for a change in environment,improvement of morale or general improvement of health, isnot reimbursable, even if it is taken at the advice of a doctor.See Spa or resort.Tubal ligation - Expenses incurred for a tubal ligation arereimbursable.Tuition - Charges for medical care included in the tuition of acollege or private school are reimbursable if the charges areseparately stated in the tuition bill. See Learning disability andSchools, special.Tutors fees - See Learning disability.Vacation - See Trips.Vaccines - Expenses for vaccines are reimbursable.Vapor units and refills - Expenses paid for the purchase ofvapor units such as plug-in units or their refill cartridges arereimbursable.Vasectomy - Medical expenses related to a vasectomy orvasectomy reversal are reimbursable.Vent cleaning - Expenses paid for the cleaning of your homesvent system are reimbursable. Members explanation ofnecessity is required.
  17. 17. Vision care - Optometric services and medical expenses foreyeglasses and contact lenses needed for medical reasons arereimbursable. Eye exams and expenses for contact lenssolutions are also reimbursable. However, premiums for contactlens replacement insurance are not reimbursable. See Radialkeratotomy and Lasik eye surgery.Other vision services that are covered are: • contact lens cases; • corrective swim goggles; • eye charts; • eyeglass cases; • eyeglass cleaning supplies such as cleaning cloths; • reading glasses; • eyeglass repair or repair kits; • safety glasses when the lens correct visual acuity; • sunglasses or sunglass clips when the lens correct visual acuity; and • vision shaping.Vitamins - Daily multivitamins taken for general well-beingare not reimbursable. Vitamins taken to treat a specific medicalcondition are reimbursable. Physicians diagnosis letter isrequired. Prenatal vitamins, over-the-counter or obtained byprescription, are reimbursable.Wage continuation policies - Premiums paid under wagecontinuation policies are not reimbursable.Walker and accessories - Expenses paid for a walker to aidmobility and their accessories such as baskets for carrying itemsare reimbursable.Weight loss aids - Expenses paid for aids to weight loss arereimbursable when the weight loss program is to treat a medicalillness. Aids include pedometers, mixers, scales, actionplanners, recipe books and audio tapes. Physicians diagnosisletter required.Weight loss machines - See Exercise equipment.Weight loss programs, treatments and prescriptions - Thecost of weight loss programs, treatments and prescriptions forgeneral health are not reimbursable even if a doctor prescribesthem. However, if the program, treatment or prescription isprescribed by a physician to treat a medical illness (e.g., heartdisease), the expense should be reimbursable. Physiciansdiagnosis letter required.Well baby care - See Nursing services.Wheelchair - Amounts paid for an autoette or a wheelchair
  18. 18. used mainly for the relief of sickness or disability, and not justto provide transportation to and from work, are reimbursable.The cost of operating and maintaining the autoette orwheelchair is also reimbursable.Wheelchair accessories - Expenses paid for accommodationaccessories such as wheelchair backpacks are reimbursable.Wigs - See Personal use items.X-ray fees - Amounts paid for X-rays taken for medicalreasons are reimbursable.Yoga class - Expenses paid for yoga class are reimbursablewhen the activity is to treat a medical condition physiciansdiagnosis letter is required. Back to topIneligible ExpensesThe following expenses are not eligible for reimbursementunder a Health FSA, HRA or HSA • Annual medical contract fees for exclusive provider care. • Cosmetic surgery. • Dental bleaching or any other teeth whitening. • Domestic help fees (for services of a non-medical nature). • Electric toothbrush replacement brushes. • Electrolysis or hair removal. • Facial tissues, Antiviral. • Finance charges. • Fluoride - Expenses paid for over-the-counter fluorides such as toothpaste with fluoride, or fluoride mouth wash or rinse are not covered. • Hair loss treatments (non-prescription) such as over-the- counter medications are not covered. However, prescription medications prescribed by a physician to treat a medical condition are covered. • Hair transplant. • Health club dues/memberships, for general well-being unless part of a medically prescribed regimen to treat a specific condition. Physicians diagnosis letter required. • Insurance premiums of any kind. (See exceptions for HRA and HSA.) • Laetrile, even if prescribed by a doctor, is not reimbursable.
  19. 19. • Late charges. • Late payment interest. • Lens replacement insurance. • Marijuana, even if prescribed for medicinal purposes, is not reimbursable. • Massage therapy for general well-being, unless accompanied by a physicians diagnosis letter. • Medicine flavorings. • Missed appointment fees. • Newborn classes. • Over-the-counter items which are items not categorized as a medicine or drug and may include, but are not limited to, nail clippers, pumice stones, feminine hygiene products, etc., are not reimbursable, unless accompanied by a physicians diagnosis letter. Over- the-counter toiletries or personal hygiene items which may include, but are not limited to shampoo, toothpaste, conditioners, hand creams, deodorant, shaving cream, razors, dental floss, body powders, hair gels/sprays, make-up, nail polish accessories, soap, mouthwash, etc., are not reimbursable. • Physical therapy treatments for general well-being. • Pill bags. • Pre-seed moisturizers. • Shampoo that is non-medicated. • Spider vein therapy such as with sclerosing agent injections are considered cosmetic. However, if the therapy is for other than a diagnosis of spider vein therapy the charges are reimbursable when accompanied by a physicians diagnosis letter. • Supplements - The cost of supplements taken for general well-being are not reimbursable. • Tanning lotions without sun protection. • Tips paid for taxi fares, etc. • Union dues. • Vitamins - Daily multivitamins taken for general well- being are not reimbursable. • Warranties. • Weight loss program food or convenience items such as water bottles. • Weight loss machines. See Exercise equipment. Back to topIneligible Receipts
  20. 20. In addition, the following are not acceptable receipts: • Bankcard statements. • Charges submitted that are illegible. • Estimates of expenses. (A statement is required showing date of service and type of medical expense.) Back to topCapital ExpensesMedical expenses incurred by employees for special equipmentinstalled in the home or for improvements are reimbursable iftheir main purpose is medical care. Under Code Section 213,the cost of permanent improvements that increase the value ofthe property may be partly deducted as a medical expense. Thecost of the improvement is reduced by the increase in the valueof the property; the difference is a deductible medical expense.If the value of the property is not increased by theimprovement, the entire cost is deductible as a medical expense.Improvements made to accommodate a residence for a personsdisability do not usually increase the value of the residence, andthe full cost is usually reimbursable. Only reasonable costs toaccommodate a personal residence to a disabled condition areconsidered medical care. Additional costs for personal motives,such as for architectural or aesthetic reasons, are notreimbursable.WorksheetThe following worksheet may be used to figure the amount of areimbursable capital expense:Operation and Maintenance
  21. 21. 1. Enter the cost of the improvement. $__________-2. Enter the increase in the value of the home. $__________- If line 2 is equal to or greater than line 1, the amount is not reimbursable. If line 2 is less than line 1, go on to line 3.3. Subtract line 2 from line 1. $__________- This is the deductible medical expense. $__________If a capital expense qualifies as a reimbursable medicalexpense, then expenses related to operation and maintenancealso qualify as medical expenses, as long as the medical reasonfor the capital expense still exists. This is so even if none oronly part of the original capital expense qualified as a medicalcare expense.Improvements To Property Rented By A Person WithDisabilitiesAmounts paid by a person with disabilities to buy and installspecial plumbing fixtures, mainly for medical reasons, in arented house are reimbursable medical expenses. For example,Don has arthritis and a heart condition. He cannot climb stairsor get into a bathtub. On his doctors advice, he installs abathroom with a shower stall on the first floor of his two-storyrented house. Dons landlord did not pay any of the cost ofbuying and installing the special plumbing and did not lowerthe rent. Don can deduct the entire amount he paid. Back to top