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 * Shop FSA Store

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 * Employer/Broker
 * Shop FSA Store


UNIQUELY PERSONAL BENEFITS SOLUTIONS


TOGETHER, PAYFLEX AND MILLENNIUM TRUST COMPANY ARE ENABLING FINANCIAL
WELL-BEING.
WE ASPIRE TO MAKE IT SIMPLE FOR CONSUMERS TO PLAN, SAVE, AND PAY FOR THEIR
FINANCIAL FUTURE.



EXPLORE SOLUTIONS




LATEST NEWS


PAYFLEX AND MILLENNIUM TRUST ARE BECOMING INSPIRA FINANCIAL

Starting in early 2024, we are becoming Inspira, with the great service you’ve
come to expect and a renewed purpose in relentlessly pursuing better outcomes
for all.

LEARN MORE


INDIVIDUALS • EMPLOYERS / BROKERS
WHY 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 power of 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.footnote1 Plus, we’ve teamed up with FSA Store to make it easy for
you to spend your health care dollars.footnote2 


PAY

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 expenses.footnote3

Total yearly eligible health care expenses†

Average tax rate
21%
CLEAR
CALCULATE
Potential tax savings4


footnote†For best estimate, enter an amount less than or equal to the pretax
contribution limit: Health Care FSA for 2023: $3,050; HSA for 2023: $3,850
(individual coverage) and $7,750 (family coverage); Age 55 or older: You may
contribute an additional $1,000 to your HSA.




FSA STORE


THE SMART WAY TO SPEND 

Shop FSA Store for guaranteed eligibility on 2,500+ products.footnote2  You can
search by health condition, new arrivals, best sellers, personal care, medicine
and more. When you’re ready to pay, you can use your PayFlex Card® or pay with
another form of payment and submit a claim for reimbursement. Don’t let unspent
funds slip away — spend your health care dollars today!

SHOP FSA STORE


 


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. 

Need to buy an FSA-eligible product? Shop FSA Store.footnote2 

 
 
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, associated with 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 a wheelchair)
 * Autopsy
 * Baby Formula
 * Baby Health Monitor
 * 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 Modification Materials and Supplies
 * 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 general health)
 * 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)
 * COVID-19 Home Test
 * CPR
 * Crania-Sacral Therapy
 * Crown, dental
 * Crutches
 * Crystalens
 * Dance Lessons (for medical condition)
 * Dance Lessons (non-medical)
 * Decongestant
 * Deductibles
 * Defibrillator
 * Dehumidifier
 * Dehydration Treatment
 * Dehydration Treatment (rehydration sports drinks)
 * Dental Emergency Kit
 * Dental Maintenance Organization (DMO) Fees (if you have a health care 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)
 * DNA Testing Kits (ancestry portion)
 * DNA Testing Kits (health or medical portion)
 * 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 vision
   correction)
 * 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 gestational carrier
   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 cosmetic reasons)
 * Gastric Bypass Surgery Including Excess Skin Removal (for medical condition)
 * Gastric Bypass Surgery Including Excess Skin Removal (for obesity treatment)
 * Gauze Pads
 * Genetic Testing
 * GIFT (Gamete intrafallopian transfer)
 * Glucosamine and Glucosamine Chondroitin
 * Glucose Monitoring Device
 * Glucose Tabs
 * Goggles (prescription)
 * Guide Dog
 * Guide Dog (Pet Insurance)
 * Gynecologist
 * Hair Removal or Transplant (for cosmetic reasons)
 * Hair Removal or Transplant (for medical condition)
 * Half Way House
 * Hand sanitizer
 * 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 (over-the-counter)
 * 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 health care FSA)
 * Long Term Disability (LTD) Insurance Premiums (if you have an HSA)
 * Lumbar Support
 * Marijuana
 * Marriage Counseling
 * Mask (personal protective equipment)
 * 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 in another
   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)
 * Oura Ring
 * Oura Ring (extended warranty)
 * 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 Protective Equipment (PPE)
 * 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
 * Platelet-Rich Plasma (PRP) Treatment (Injections, Therapy, Transfusions)
 * 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
 * Sanitizing wipes
 * 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 is surrogate)
 * 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/treatment center)
 * Telephone for Hearing Impaired (fees for enhancing/repairing a phone)
 * Television for Visually or Hearing Impaired (cost of TV in hospital/treatment
   center)
 * Television for Visually or Hearing Impaired (cost to modify TV or buy new)
 * Temporary Continuation of Coverage (TCC) Premiums (if you have a health care
   FSA)
 * Temporary Continuation of Coverage (TCC) Premiums (if you have an HSA)
 * 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)
 * Transgender Counseling
 * Transgender Surgery
 * 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 From Work
 * 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 medical condition)
 * 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 Acne Treatment.
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.
Eligible
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.
Required
Acupuncture
The cost of acupuncture is an eligible medical expense.
Eligible
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.
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 with birth)
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.
Eligible
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.
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 standard form.
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.
Required
Alternative 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.
Eligible
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.
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.
Eligible
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.
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.
Eligible
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.
Eligible
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.
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.
Eligible
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.
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 medical expense.
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.
Eligible
Autopsy
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
Baby Health Monitor
The cost of a baby monitor that monitors and tracks a baby’s heart rate and/or
breathing while they sleep, is an eligible medical expense. Examples include but
are not limited to: Owlet, Miku, Nanit
Eligible
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.
Ineligible
Back Brace
Both Rigid (Hard) and Soft (Elastic) Back Braces are eligible medical expenses.
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.
Required
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.
Eligible
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.
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 these surgeries.
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 birth defect.
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 that portion.
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 medical condition.
Required
Bleaching or Whitening Teeth
The cost of bleaching or whitening teeth is not an eligible medical expense.
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.
Required
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. 
Required
Blood Pressure Monitor
The cost of a blood pressure monitoring device is an eligible medical expense.
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 Modification Materials and Supplies
A health care professional must provide evidence of medical necessity for the
cost of body modification materials and supplies 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. Eligible
expenses may include but are not limited to gaffing devices, binders and
prosthetics.
Required
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.
Required
Body 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 is needed.
Ineligible
Bracanalysis Testing
The cost of diagnostic testing for genetic mutations that may include DNA
collection is an eligible medical expense.
Eligible
Braces, 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 standard form.
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 medical expense.
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.
Eligible
Breathalyzer
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 medical condition.
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 medical expense
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.
Required
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.
Required
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.
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.
Ineligible
Childbirth
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 that portion.
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.
Eligible
Chiropody
Amounts paid to a chiropodist (a chiropractic foot doctor) is an eligible
medical expense.
Eligible
Chiropractor
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.
Ineligible
Circumcision
The cost of circumcision is an eligible medical expense.
Eligible
Clinic
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 medical expense. 
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 medical condition.
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.
Required
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.
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.
Eligible
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 is needed.
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 medical expense.
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).
Required
Copayment (copay)
A medical copayment is an eligible medical expense. Note: The receipt must
clearly state that the expense is a copayment for a healthcare service.
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. 
Ineligible
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 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.
Ineligible
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 cough drops.
Eligible
Counseling (for medical condition)
The cost of counseling for a medical condition is an eligible medical expense.
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.
Ineligible
COVID-19 Home Test
The cost of home testing for COVID-19 is an eligible medical expense.
Eligible
CPR
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.
Required
Crown, dental
The cost of a crown is an eligible medical expense.
Eligible
Crutches
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 expenses.
Ineligible
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.
Eligible
Defibrillator
The cost of a defibrillator is an eligible medical expense.
Eligible
Dehumidifier
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 and hydrating electrolytes.
Eligible
Dehydration Treatment (rehydration sports drinks)
The cost of rehydration sports drinks, such as Gatorade, and solutions with
dietary supplements other than electrolytes are not eligible.
Ineligible
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 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
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.
Required
Dental, cosmetic
The cost of cosmetic dental treatment is not an eligible medical expense.
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.
Eligible
Denture Cleanser
The cost for a product to clean dentures is an eligible medical expense.
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.
Eligible
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.) 
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.
Eligible
Diathermy
The cost of diathermy used to destroy abnormal cells or as a form of physical
therapy is an eligible medical expense.
Eligible
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.
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.
Required
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 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
Ineligible
DNA Testing Kits (ancestry portion)
The cost of the ancestry portion is not an eligible expense.

Note: If the documentation states Health + Ancestry, a breakdown of the cost for
each will be required. Only the health (or medical care) portion is eligible.
Ineligible
DNA Testing Kits (health or medical portion)
The cost of the testing kit’s health or medical care portion is an eligible
medical expense.

Examples include but are not limited to: 23andMe, Ancestry, EverlyWell and
MyHertiage
Eligible
Doctor Fees
The cost of doctor fees are an eligible medical expense.
Eligible
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 medical condition.
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 medical expense.
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 medical expense.
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.
Eligible
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 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.
Eligible
Ear Plugs
A health care professional must provide evidence of medical necessity for the
cost of ear plugs 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.
Required
Ear, 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.
Required
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.
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.
Ineligible
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.
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.
Eligible
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.
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.
Required
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.
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.
Ineligible
Experimental 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 vision correction)
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 carrier expenses)
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.
Required
Finance 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.
Eligible
First Aid Kit
The cost of a first aid kit is an eligible medical expense.
Eligible
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.
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 medical condition.
Required
Flavoring Added to Medication
The cost of adding flavoring to medication is an eligible medical expense.
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.
Ineligible
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
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.
Eligible
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 form
Ineligible
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 2023, the eligible rate is $0.22 per mile. For January
1, 2022 through June 30, 2022, the eligible rate is $0.18 per mile. For July 1,
2022 through December 31, 2022, the eligible rate is $0.22 per mile. Note:
Long-distance travel cannot be for purely personal reasons.
Eligible
Funeral Expenses
The cost of a funeral is not an eligible medical expense.
Ineligible
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.
Required
Gastric Bypass Surgery Including Excess Skin 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
Gastric Bypass Surgery Including Excess Skin Removal (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
Gastric Bypass Surgery Including Excess Skin Removal (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 these surgeries.
Eligible
Gauze Pads
Gauze pads are an eligible medical expense.
Eligible
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.
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.
Eligible
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.
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.
Eligible
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.

Amounts paid for the care of a specially trained animal are also eligible
medical expenses. This includes any costs incurred in maintaining the animal's
health and vitality so that it may perform its duties, such as costs for food,
grooming and veterinary care.

Note: The cost of Pet Insurance for the animal is NOT an eligible expense.
Eligible
Guide Dog (Pet Insurance)
The cost of Pet Insurance for the animal is not an eligible expense.
Ineligible
Gynecologist
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.
Required
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 medical condition.
Required
Hand sanitizer
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 are eligible
medical expenses.
Eligible
Handicap, Disability Placards and License Plates
The cost of handicap license plates/placards is an eligible medical expense.
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.
Ineligible
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.
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.
Required
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 medical expenses.
Eligible
Hearing Aids (over-the-counter)
Amounts paid for over-the-counter hearing aids are eligible medical expenses.
Screenings to obtain the hearing aids are also eligible medical expenses.
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.
Eligible
Heating 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, home
testing for COVID-19 and pregnancy tests.
Eligible
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.
Eligible
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.
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
Eligible
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.
Eligible
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.
Ineligible
Human 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.
Eligible
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.
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.
Required
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 the medical condition.
Required
Illegal Operations, Illegal Treatments
The cost of an illegal operation or other treatment is not an eligible medical
expense. 
Ineligible
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.
Eligible
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 medical condition.
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.
Eligible
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.
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.
Required
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.
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.
Required
Laboratory 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
Eligible
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.
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 that portion.
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 these surgeries.
Eligible
LASIK, Laser Eye Surgery
The cost of LASIK/PRK or radial keratotomy surgery is an eligible medical
expense. 
Eligible
Late Payment Fee
A late fee associated with a medical payment is not an eligible medical
expense. 
Ineligible
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. 
Eligible
Lead Paint Correction (repaint affected area)
The cost to repaint the affected area is not a eligible medical expense.
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 medical expenses
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 expenses.
Ineligible
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.
Eligible
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.
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 medical condition.
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 from home.
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 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 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.
Eligible
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.
Required
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.
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.
Ineligible
Mask (personal protective equipment)
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 are eligible
medical expenses.
Eligible
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.
Eligible
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.
Eligible
Maternity Charges
Amounts paid to a physician or licensed midwife for delivery charges are
eligible medical expenses.
Eligible
Maternity 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 the costs.
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 medical expense.
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.
Eligible
Medical Newsletter
The cost of a medical newsletter is not an eligible medical expense. A
newsletter does not directly treat a medical condition. 
Ineligible
Medical 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 in another
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 country for 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 medical expense.
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.
Ineligible
Mediscope
The cost of a medical device used to provide bright illumination during an
examination of ears, nose and throat is an eligible medical expense.
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.
Ineligible
Midwife
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 2023, the eligible rate is $0.22 per mile. For January
1, 2022 through June 30, 2022, the eligible rate is $0.18 per mile. For July 1,
2022 through December 31, 2022, the eligible rate is $0.22 per mile. 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. 
Ineligible
Monitor
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.
Eligible
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.
Eligible
Mouth Guard
The cost of a Mouth Guard is an eligible medical expense. This is true for
prescription and OTC.
Eligible
Nasal 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 medical expense. 
Eligible
Neti Pot
The cost of a neti pot used for sinus and allergy relief is an eligible medical
expense.
Eligible
Neurologist
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.
Eligible
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 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.
Required
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.
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 medical expense.
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.
Ineligible
Orthodontia
The cost of orthodontia care (including braces and invisalign) is an eligible
medical expense.
Eligible
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 and astigmatism.
Eligible
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
regular shoe is eligible.
Required
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.
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.
Eligible
Osteopath
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 medical expense.
Eligible
Oura Ring
The cost of an Oura Ring is an eligible medical expense. The Oura Ring monthly
membership fee is also an eligible medical expense.
Eligible
Oura Ring (extended warranty)
An extended warranty for the Oura Ring is not an eligible medical expense.
Ineligible
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 medical expenses.
Eligible
Over-the-Counter (OTC) Drugs and Medicines
The cost of an OTC product, drug or medicine is an eligible medical expense.
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.
Eligible
Ovulation 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.
Eligible
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.
Ineligible
Paternity 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.
Eligible
Peak Flow Meter
The cost of a nebulizer or peak flow meter is an eligible medical expense. 
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.
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 the medical condition.
Required
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 the medical condition.
Required
Personal Items
Products used for personal grooming and hygiene are not eligible medical
expenses.
Ineligible
Personal Protective Equipment (PPE)
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 are eligible
medical expenses.
Eligible
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.
Required
PET Scan
Cost for a PET scan which is a nuclear medicine imaging technique is an eligible
medical expense.
Eligible
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.
Eligible
Phone Consultation with Doctor
The cost of a phone consultation with a Medical provider is an eligible medical
expense. This includes TelaDoc services.
Eligible
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.
Required
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.
Eligible
Physical Exam for Caregiver
The cost of a physical exam for a potential caregiver is not an eligible medical
expense.
Ineligible
Physical 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 medical expense.
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
Platelet-Rich Plasma (PRP) Treatment (Injections, Therapy, Transfusions)
A health care professional must provide evidence of medical necessity for the
cost of Platelet-Rich Plasma (PRP) Treatment (including, but not limited to PRP
injections, PRP therapy and PRP transfusions). 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.
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 birth expenses.
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.
Eligible
Pregnancy 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.
Eligible
Prenatal Vitamins
The cost of Prenatal vitamins is an eligible medical expense.
Eligible
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. 
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 medical expense. 
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 medical expense.
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.
Required
Prosthesis
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.  
Eligible
Psychotherapist
Fees paid for Psychotherapy are eligible medical expenses.
Eligible
Psychotherapy
Fees paid for Psychotherapy are eligible medical expenses; this would include
Individual and Family Psychotherapy.
Eligible
Pulse Oximeter
The cost of a pulse oximeter which checks oxygen levels and pulse rates is an
eligible medical expense.
Eligible
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 the medical condition.
Required
Radial Keratotomy
The cost of radial keratotomy is an eligible medical expense.
Eligible
Reading 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.
Eligible
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 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 permanent residence.
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.
Ineligible
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 is needed.
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 medical expense.
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 medical expense.
Eligible
Sales Tax
Sales tax incurred for a medical service or product (including OTC) are eligible
medical expenses. 
Eligible
Sanitizing wipes
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 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.
Required
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.
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.
Eligible
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.
Required
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.
Required
Shampoos and Soaps
Products used for personal grooming and hygiene (like shampoos and soaps) are
not eligible medical expenses.
Ineligible
Sharps 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.
Eligible
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.
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 medical expense.
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.
Eligible
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.
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.
Required
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.
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.
Eligible
Speech 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. 
Ineligible
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.
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 medical expense.
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.
Required
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.
Eligible
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. 
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 medical expense.
Eligible
Telephone for Hearing Impaired (cost of phone in hospital/treatment center)
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 buy new)
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 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
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 with radiation.
Eligible
Thermometer
The cost of a thermometer for medical use (e.g., to take someone’s temperature)
is an eligible medical expense.
Eligible
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.
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.
Eligible
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. 
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.
Eligible
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.
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.
Eligible
Transgender Counseling
The cost of transgender counseling is an eligible medical expense.
Eligible
Transgender Surgery
The cost of transgender surgery is an eligible medical expense.
Eligible
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, HSA or 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 medical care is eligible. For
2023, the eligible rate is $0.22 per mile. For January 1, 2022 through June 30,
2022, the eligible rate is $0.18 per mile. For July 1, 2022 through December 31,
2022, the eligible rate is $0.22 per mile. 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 medical condition.
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 from home.
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 birth defect.
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.
Ineligible
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.
Required
Ultrasound
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. 
Ineligible
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.
Eligible
Usual, Customary and Reasonable (UCR), Charges Above
Amounts that exceed reasonable and customary charges are eligible medical
expenses.
Eligible
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.
Required
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.
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 medical expense.
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.
Eligible
Vision 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.
Required
Walker
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.
Eligible
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).
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 medical expense.
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 medical expense.
Eligible
Wellness Scan
A wellness scan is an eligible medical expense. This is generally used to find
signs of medical problems.
Eligible
Wheelchair, 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.
Eligible
X-Ray
The cost of X-ray fees for medical care is an eligible medical expense.
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
 
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Eligible Required(Letter of Medical Necessity required) Ineligible
Eligible
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 Acne Treatment.
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 eligible medical 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 medical expense.
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.
Baby Health Monitor
The cost of a baby monitor that monitors and tracks a baby’s heart rate and/or
breathing while they sleep, is an eligible medical expense. Examples include but
are not limited to: Owlet, Miku, Nanit
Back Brace
Both Rigid (Hard) and Soft (Elastic) Back Braces are eligible medical expenses.
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 these surgeries.
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 that portion.
Blood Pressure Monitor
The cost of a blood pressure monitoring device is an eligible medical expense.
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 eligible medical 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 standard form.
Breast Pump Purchase or Rental
The cost to purchase or rent a breast pump is an eligible medical expense.
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 and containers.
Breathalyzer
The cost of both in-home and doctor's office alcohol testing are eligible
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 medical expense
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 that portion.
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 eligible medical
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 medical expense. 
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 eligible medical
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: Abreva Cream, 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 medical expense.
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 healthcare service.
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 and astigmatism.
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 cough drops.
Counseling (for medical condition)
The cost of counseling for a medical condition is an eligible medical expense.
COVID-19 Home Test
The cost of home testing for COVID-19 is an eligible medical expense.
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 eligible medical 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 and hydrating electrolytes.
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 medical expense.
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.
DNA Testing Kits (health or medical portion)
The cost of the testing kit’s health or medical care portion is an eligible
medical expense.

Examples include but are not limited to: 23andMe, Ancestry, EverlyWell and
MyHertiage
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 medical expense.
Drugs (over-the-counter)
The cost of an OTC product, drug or medicine is an eligible medical expense.
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.
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 eligible medical 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 medical expense.
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 2023, the eligible rate is $0.22 per mile. For January
1, 2022 through June 30, 2022, the eligible rate is $0.18 per mile. For July 1,
2022 through December 31, 2022, the eligible rate is $0.22 per mile. Note:
Long-distance travel cannot be for purely personal reasons.
Gastric Bypass Surgery Including Excess Skin Removal (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 these surgeries.
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 eligible medical
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.

Amounts paid for the care of a specially trained animal are also eligible
medical expenses. This includes any costs incurred in maintaining the animal's
health and vitality so that it may perform its duties, such as costs for food,
grooming and veterinary care.

Note: The cost of Pet Insurance for the animal is NOT an eligible expense.
Gynecologist
The cost of gynecological care is an eligible medical expense.
Hand sanitizer
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 are eligible
medical expenses.
Handicap, Disability Placards and License Plates
The cost of handicap license plates/placards is an eligible medical expense.
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 medical expenses.
Hearing Aids (over-the-counter)
Amounts paid for over-the-counter hearing aids are eligible medical expenses.
Screenings to obtain the hearing aids are also eligible medical expenses.
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, home
testing for COVID-19 and 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 eligible medical 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 eligible medical
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 that portion.
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 these surgeries.
LASIK, Laser Eye Surgery
The cost of LASIK/PRK or radial keratotomy surgery is an eligible medical
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 eligible medical 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 eligible medical
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 from home.
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.
Mask (personal protective equipment)
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 are eligible
medical expenses.
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.
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 medical expense.
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.
Medical Records
The cost of transferring or copying medical records is an eligible medical
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 medical
expenses.  
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: Abreva Cream, Herpecin.
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.
Medicine and Drugs from Other Countries (purchased and consumed in another
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 medical expense.
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 medical expense.
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 eligible medical 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 2023, the eligible rate is $0.22 per mile. For January
1, 2022 through June 30, 2022, the eligible rate is $0.18 per mile. For July 1,
2022 through December 31, 2022, the eligible rate is $0.22 per mile. 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 eligible medical 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 medical expense. 
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 gum and 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 and containers.
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 medical expense.
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 and astigmatism.
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 medical expense.
Oura Ring
The cost of an Oura Ring is an eligible medical expense. The Oura Ring monthly
membership fee is also an eligible medical expense.
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 medical expenses.
Over-the-Counter (OTC) Drugs and Medicines
The cost of an OTC product, drug or medicine is an eligible medical expense.
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 medical expense. 
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.
Personal Protective Equipment (PPE)
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 are 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 medical expense.
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.
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. 
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 birth expenses.
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 medical expense. 
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 medical expense.
Sales Tax
Sales tax incurred for a medical service or product (including OTC) are eligible
medical expenses. 
Sanitizing wipes
Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing
wipes, for the primary purpose of preventing the spread of COVID-19 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 prostate cancer 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 medical expense.
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 medical expense.
Stop-Smoking Program
The cost of a smoking cessation or stop-smoking program is an eligible medical
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 eligible medical 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 medical expenses. 
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 medical expense.
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 buy new)
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 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.
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 with radiation.
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.
Transgender Counseling
The cost of transgender counseling is an eligible medical expense.
Transgender Surgery
The cost of transgender surgery is an eligible medical expense.
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, HSA or 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 medical care is eligible. For
2023, the eligible rate is $0.22 per mile. For January 1, 2022 through June 30,
2022, the eligible rate is $0.18 per mile. For July 1, 2022 through December 31,
2022, the eligible rate is $0.22 per mile. 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 from home.
Tubal Ligation, Tubal Ligation Reversal
The cost of a tubal ligation or tubal ligation reversal is an eligible medical
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 eligible medical
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 eligible medical
expense.
Vasectomy, Vasectomy Reversal
The cost of a vasectomy or vasectomy reversal is an eligible medical expense.
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 eligible medical
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 medical expense.
Well Baby, Well Child Care
The cost of preventative and wellness checks is an eligible medical expense.
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 medical expense.
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 standard form.
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 birth defect.
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 medical condition.
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.
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 eligible medical
expense.
Body Modification Materials and Supplies
A health care professional must provide evidence of medical necessity for the
cost of body modification materials and supplies 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. Eligible
expenses may include but are not limited to gaffing devices, binders and
prosthetics.
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 medical condition.
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.
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 medical condition.
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 the medical 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 the medical 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 medical condition.
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 the medical condition.
Ear Plugs
A health care professional must provide evidence of medical necessity for the
cost of ear plugs 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.
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 an eligible 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 medical condition.
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.
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 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.
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 medical condition.
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 the medical 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 medical condition.
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 the medical 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 the medical 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 medical condition.
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 the costs.
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 eligible medical 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
regular shoe 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 the medical 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 the medical 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.
Platelet-Rich Plasma (PRP) Treatment (Injections, Therapy, Transfusions)
A health care professional must provide evidence of medical necessity for the
cost of Platelet-Rich Plasma (PRP) Treatment (including, but not limited to PRP
injections, PRP therapy and PRP transfusions). 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.
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.
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 the medical 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 the medical 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 the medical 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 permanent residence.
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.
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.
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.
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 medical condition.
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 birth defect.
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 at www.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 the medical 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 eligible medical expenses.
Adoption Medical Expenses (incurred by birth mother, associated with birth)
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 eligible medical
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 medical expense.
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 is needed.
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 eligible medical
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 eligible medical 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 health care 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 is needed.
Contact Lens Service Agreement and Warranty
Any fees for vision discount programs or warranties are not eligible medical
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 medical expenses. 
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 expenses.
Dehumidifier
The cost of a dehumidifier is not an eligible medical expense.
Dehydration Treatment (rehydration sports drinks)
The cost of rehydration sports drinks, such as Gatorade, and solutions with
dietary supplements other than electrolytes are not eligible.
Dental Maintenance Organization (DMO) Fees (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.
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 medical expense.
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 medical expenses.
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 eligible medical expense
DNA Testing Kits (ancestry portion)
The cost of the ancestry portion is not an eligible expense.

Note: If the documentation states Health + Ancestry, a breakdown of the cost for
each will be required. Only the health (or medical care) portion is 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.
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 a replacement.
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 medical expenses.
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 vision correction)
Amounts paid for over-the-counter sunglasses, as well as eyeglasses not needed
for vision correction or reading, are not eligible medical expenses.
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 gestational carrier 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 medical expenses.
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 form
Founder’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 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.
Guide Dog (Pet Insurance)
The cost of Pet Insurance for the animal is not an eligible expense.
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 eligible medical 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 medical expenses.
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.
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 eligible medical
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 eligible medical
expense. 
Lead Paint Correction (repaint affected area)
The cost to repaint the affected area is not a eligible medical expense.
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 medical expenses
Legal Fees (for surrogate mother)
Legal fees in connection with a surrogate mother are not eligible medical
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 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.
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 medical expenses.
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 health care 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 country for 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 eligible medical
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 medical expenses.
Missed Appointment Fees
A fee paid for a missed appointment is not an eligible medical expense. 
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 eligible medical
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 medical expenses. 
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 care FSA, HSA or HRA.
Oura Ring (extended warranty)
An extended warranty for the Oura Ring is not an eligible medical expense.
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 eligible medical expense
Personal Items
Products used for personal grooming and hygiene are not eligible medical
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 eligible medical 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 medical expense.
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 is needed.
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 medical expense.
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 eligible medical
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 medical expenses. 
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 medical expenses.
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 eligible medical 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/treatment center)
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 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.
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 medical expenses. 
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.
You are now past this feature
 

footnote1Promotional offers, available in-store at CVS Pharmacy or online at
CVS.com for eligible PayFlex HSA/FSA members.

footnote2FSAstore.com is an independent service provider not affiliated with
PayFlex. The link provided is for your convenience and is not an endorsement of
FSA Store’s services or the provision of legal, medical, financial or tax
advice. PayFlex may receive compensation on certain products purchased at
FSAstore.com.

footnote3You’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 other dental 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 or hearing expenses

footnote4Savings 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 tax rate.

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