Flexible spending account expense guide

Transcription

1 Flexible spending account expense guide or the UniAccount SM FSA This guide provides details about: Things that are and are not allowed expenses for the FSA. These lists are based on IRS rules. Keep in mind that these are general guidelines only. There are gray areas. For example, some expenses are allowed only if you have a doctor s order. If in doubt, talk with a qualified accountant, tax advisor or financial planner. How to get reimbursed (paid back) from your FSA for an expense. Whenever you have an expense that you want to use your FSA for, be sure to keep a supporting document such as a detailed receipt. To get paid back, you may need to send this document along with a claim form. Health care FSA: Expense list Expense Description FSA Eligible Limited tes Acne treatments Must be used to treat a specific medical condition. Acupuncture Adoption, medical expense Potentially For medical expenses before an adoption is final, if the child was a legal dependent when the services were rendered. Need legal documents related to adoption. Alcohol and drug rehab Allergy medicine Potentially Prescription required. Allergy product and home improvements to treat severe allergies Potentially If the product would be owned without the allergy, then the expense is not considered eligible. See Capital expenses. Alternative healers Potentially Letter of medical necessity required. Ambulance transport Antacid Potentially Prescription required. Antihistamine Potentially Prescription required. Artificial limbs Artificial teeth Aspirin Potentially Prescription required. Bandages Batteries for durable medical equipment Must note usage of batteries on receipt CAMENABC 03/12

2 Expense Description FSA Eligible Limited tes Birth control pills Blood pressure monitoring devices Blood sugar test kit and test strips Body scan/diagnostic testing Braille books and magazines Potentially Only the amount above the cost of regular printed material is reimbursable. Letter of medical necessity required. Breast reconstruction surgery following mastectomy Burn garment Capital expenses Potentially The main purpose must be for the medical care of the taxpayer, spouse, or dependent. The following information must be provided: A letter and/or prescription from a physician citing the medical necessity. A written certification that states the item is for the patient s individual use, or the percentage of use in relation to other members of the household. Third-party appraisal of the participant s home to substantiate the difference between cost of capital expenditure and the increase in value to the participant s home (the cost of the appraisal is not reimbursable). Carpal tunnel wrist support Chelation (EDTA) therapy Only if used to treat a medical condition such as lead poisoning. Letter of medical necessity required. Childbirth classes Chiropractors Christian Science practitioner Circumcision COBRA premiums Coinsurance, copays and deductibles dental Coinsurance, copays and deductibles medical Coinsurance, copays and deductibles vision Cold medicine Potentially Prescription required. Cold packs Condoms Contact lenses, materials and equipment Contraceptives Controlled substances in violation of federal law Cosmetics

3 Expense Description FSA Eligible Limited tes Cosmetic prescriptions CPR classes Potentially Letter of medical necessity required. Decongestants Potentially Prescription required. Dental visits (not cosmetic) Cosmetic dental procedures are not eligible. Dentures Deodorant Diabetic supplies Diagnostic services Diapers and diaper service for newborns Diaper rash ointments and creams Diarrhea medicine Potentially Prescription required. Dietary supplements Potentially Letter of medical necessity required. Diet foods DNA collection and storage Doula (birthing coach) Potentially Letter of medical necessity required. Drug addiction treatment Drug overdose, treatment of Dual-purpose expenses (items that have both Potentially Letter of medical necessity required. a medical and general/personal/cosmetic purpose) Durable medical equipment Dyslexia Potentially Letter of medical necessity required. Ear plugs Potentially Letter of medical necessity required. Egg donor fees Eggs and embryos storage Only temporary storage is eligible. Letter of medical necessity required. Electrolysis or hair removal Elevator Potentially See Capital expenses. Exercises equipment or programs Potentially Letter of medical necessity required. Expenses reimbursed by a health reimbursement account Eye examination, eyeglasses, equipment and materials Face cream and moisturizers Face lifts Family counseling Potentially t unless recommended to treat a medical disorder. Letter of medical necessity required. Feminine hygiene products Fertility treatments Fiber supplements Potentially Letter of medical necessity required.

4 Expense Description FSA Eligible Limited tes First aid cream First aid kits Flu shots Fluoridation devices Foods Potentially See Special foods. Founder s fee Gauze pads Genetic testing Potentially If ordered for medical care. GIFT Glucosamine Potentially See Dual-purpose expenses. Glucose monitoring equipment Glucose tablets Guide dog, other animal aide Potentially Letter of medical necessity required. Hair colorants Hair removal and transplants Hand lotion Health club dues and fees Hearing aids Hemorrhoid treatment Potentially Prescription required. Herbs Potentially Letter of medical necessity required. Hormone replacement therapy (HRT) Potentially Only if used to treat a medical condition. Hospital services Hot packs Household help Illegal operations and treatment Immunization Inclinator Incontinence supplies Insect bite creams and ointments Insulin Insurance premiums Laboratory fees Lactaid Potentially Prescription required. Lactation consultation Lamaze classes Only the portion of the class covering the birthing process is eligible. Language training Potentially Letter of medical necessity required. Lasik eye surgery Laxatives Potentially Prescription required.

5 Expense Description FSA Eligible Limited tes Lead-based paint removal Potentially Eligible if done to prevent a child who has or had lead poisoning from eating paint. The wall surface must be within the child s reach. Letter of medical necessity required. Learning disability Potentially If for a child with dyslexia or disabled child. But school fees for regular schooling normally don t qualify. Lifetime care advance payment Liquid adhesive for small cuts Potentially Lodging at a hospital or similar institution (patient only) Lodging of a companion If accompanying a patient for medical treatment. Lodging not at a hospital or similar institution Up to $50 per night if the lodging is mainly for and essential to medical care. The service must be provided by a doctor in a licensed hospital or medical care facility equivalent to a licensed hospital. An extra $50 per night may be reimbursable for a parent or companion who must accompany the patient. Long-term care premiums Marijuana or other controlled substances in violation of federal law Marriage counseling Massage therapy Potentially Letter of medical necessity required. Mastectomy-related special bras Potentially Letter of medical necessity required. Maternity clothes Meals at a hospital or similar institution (patient only) Meals not at a hospital or similar institution Meals of companion Meals; attending a medical conference Medic Alert bracelet Medicare Part B premiums Medical conference admission Potentially Letter of medical necessity required. Medical information plan changes Medical monitoring and testing devices Medical newsletter Medical record charges Medical services Medicated lip balm Product must be listed as either medicated or having an SPF for sun protection. Menstrual pain relievers Potentially Motion sickness pills Mouthwash Nasal sprays Potentially Prescription required. Nasal strips Potentially Prescription required.

6 Expense Description FSA Eligible Limited tes Naturopathic healers Nebulizer Nicotine gum and patches Potentially nprescription drugs used to treat a specific medical condition nprescription drugs used for general health and/or cosmetic purposes nprescription drugs dual purpose rplant insertion or removal Nursing home expenses Nursing services provided by a nurse or other attendant Nutritionist s professional expenses Potentially Letter of medical necessity required. OB/GYN Occlusal guards Office visits dental Office visits medical Office visits vision Operations dental Legal operations only. Cosmetic procedures are not eligible. Operations medical Legal operations only. Cosmetic procedures are not eligible. Operations vision Legal operations only. Cosmetic procedures are not eligible. Optometrist Organ donors Orthodontia Orthopedic shoes and inserts Osteopath fees Over-the-counter (OTC) pregnancy test/ Potentially fertility Ovulation monitor Potentially Oxygen Pain relievers Potentially Prescription required. Personal-only expenses Physical exams Employment-related exams are not eligible. Physical therapy Podiatrist Pregnancy termination Legal terminations only. Pregnancy test kits Potentially Prenatal vitamins Potentially Prescription drugs used to treat a specific medical condition

7 Expense Description FSA Eligible Limited tes Prescription drugs used for general health and/or cosmetic purposes Prescription drugs dual purpose Potentially Only if used mainly to prevent or alleviate a physical or mental defect or illness. Prescription drugs imported from another Prescribed by a doctor to address a medical condition. country Prescription drug discount programs Prescription eyeglasses Propecia Potentially Only if hair loss is due to a medical condition. Letter of medical necessity required. Prosthesis Psychiatrist Psychoanalysis Psychologist Radial keratotomy Reading glasses Recliner chairs Retin-A Potentially Letter of medical necessity required. Reversal of tubal ligation or vasectomy Rogaine Potentially Only if hair loss is due to a medical condition. Rubbing alcohol Safety glasses Sales tax on qualified medical expenses School and education residential School and education, special Potentially Only if recommended by a physician. Letter of medical necessity required. Screening tests dental or vision Screening test medical Shipping and handling fees on eligible expenses Sick-child facility Sinus medications Potentially Prescription required. Skin moisturizer Sleep deprivation treatment Potentially Letter of medical necessity required. Smoking cessation Potentially Special foods Potentially Letter of medical necessity required. Spermicidal foam Potentially Sperm storage fees Potentially Temporary storage only. Letter of medical necessity required. St. John s Wort Potentially Letter of medical necessity required. Stem cell, harvesting and/or storage Potentially Letter of medical necessity required.

8 Expense Description FSA Eligible Limited tes Sterilization procedures Student health fee Sunglasses clips Sunglasses (prescription) Sunglasses (nonprescription) Sunburn creams and ointments Potentially Sunscreen Potentially Supplies to treat a medical condition Surrogate expenses Take-home drug test Potentially Take-home pregnancy test Take-home urinary tract infection test Teeth whitening Telephone for hearing impaired persons Therapy Thermometers Throat lozenges Potentially Prescription required. Toiletries Toothache and teething pain relievers Potentially Prescription required. Toothbrushes Toothpaste Transplants Transportation and travel expenses for Contact UniAccount for mileage rates. person receiving dental care Transportation and travel expenses for Contact UniAccount for mileage rates. person receiving medical care Transportation and travel expenses for Contact UniAccount for mileage rates. person receiving vision care Transportation of someone other than the Potentially Potentially Only for certain cases: person receiving dental or vision care A parent who must travel with a sick child getting medical care. A nurse or other person who gives medication or injections to a patient. Visits to a mentally ill dependent, if recommended as part of treatment. Transportation of someone other than the Potentially Only for certain cases: person receiving medical care A parent who must travel with a sick child getting medical care A nurse or other person who gives medication or injections to a patient. Visits to a mentally ill dependent, if recommended as part of treatment Tubal ligation

9 Expense Description FSA Eligible Limited tes Umbilical cord freezing and storage Potentially Collection and storage indefinitely in case needed is not eligible for reimbursement. Vaccines Varicose vein, treatment of Vasectomy Veneer Vision discount programs Vitamins Potentially Letter of medical necessity required. Walker Wart remover treatment Potentially Only to treat a medical condition. Prescription required. Weight-loss programs and/or drugs Potentially Letter of medical necessity required. prescribed to induce weight loss Wigs Potentially Only if hair loss is due to a medical condition. Letter of medical necessity required. *A limited FSA cannot be used for medical expenses. It is designed to work with a health savings account (HSA) that can be used for these expenses.

10 Health care FSA: How to get paid back Option 1: Automatic payment If you have an Anthem plan, you may get paid back automatically. Here s an example: 1. You go to the doctor and you pay a copay at the time of your visit. 2. Anthem processes a claim and decides that you have an out-of-pocket cost (the copay). 3. Anthem tells UniAccount, and UniAccount sends you a check for the copay amount (as long as you have money in your FSA). For Anthem HMO plan members, UniAccount can also do automatic payment for prescription drug copays and hospital coinsurance. Automatic payment only works if Anthem is your only plan and Anthem processes the claim. For anything else, you would need to send a claim form. Option 2: Send a claim form If you don t get automatic payment, you can send a claim form to UniAccount. To download a form online, go to anthem.com/ca. You will need to send at least one supporting document along with your claim form. This could be: An Explanation of Benefits (EOB) from your insurance company. The EOB needs to show the date of service for your out-of-pocket expenses. An itemized statement from the service provider. The statement should include the patient s name, dates of service, procedure descriptions, provider name, and charges for the service. Anything that doesn t show this level of detail (such as an account balance statement or cancelled check) does not meet IRS rules for a form of proof. For prescription drugs, a pharmacy statement or detailed receipt. This should include the name of the pharmacy, patient s name, date of fill, cost, Rx number and name of the drug. You can get FSA reimbursement for an over-the-counter (OTC) medicine only if you have a prescription for the medicine. Be sure to sign at the bottom of the claim form. You can send your claim form and supporting documents to UniAccount in one of two ways: Mail to: UniAccount P.O. Box 4381 Woodland Hills, CA Fax to:

11 Dependent care FSA: Expense list To be eligible, dependent care expenses must allow you and your spouse (if you re married) to: Work (not including unpaid volunteer work or volunteer work for a nominal salary). Actively look for work. Spouses are considered to have worked if: They were a full-time student for at least five calendar months during the tax year. They were physically or mentally unable to care for themselves. Also keep in mind: An eligible dependent must be either: Under the age of 13 years old. Mentally or physically unable to care for themselves. You may not claim any other tax benefits for the tax-free amounts you get from the dependent care FSA. Expenses not paid with your FSA may be eligible for the dependent care credit. Talk to your tax advisor the tax credit may work in your favor more than a dependent care FSA. For divorced parents: The custodial parent can be reimbursed from the dependent care FSA. The noncustodial parent cannot be reimbursed from the dependent care FSA. This rule applies even when the noncustodial parent is entitled to the dependency exception (for instance, because the custodial parent is not claiming it). Expense Description Dependent Care tes FSA Eligible After-school care Agency fees Potentially May be employment-related expenses if the participant is required to pay these fees to get care. Cannot be reimbursed until the care is provided. Forfeited fees are not eligible for reimbursement. Au pair Amount paid for actual care of the dependent are eligible. Care for a spouse or other tax dependent Potentially Person must live in the participant s home at least eight hours a day. who is physically or mentally incapable of self-care Care for person not residing with participant Childcare placement fees Early-morning care Field trips/activity fees Unless inseparable from the cost of care. Lesson in lieu of care Material fees Unless inseparable from the cost of care. Meals Unless inseparable from the cost of care. Nanny Only actual care of the dependent is eligible. Nursing home care for spouse or other tax dependent who is physically or mentally incapable of self-care

12 Expense Description Overnight camp Payments to the participant s spouse or to the parent of the participant s child who is not the participant s spouse Dependent Care FSA Eligible tes Registration fees Potentially May be employment-related expenses if the participant is required to pay these fees to get care. Cannot be reimbursed until the care is provided. Forfeited fees are not eligible for reimbursement. School tuition for kindergarten or above Sick child facility Summer day camp Advance payment for the entire summer is not eligible. Expenses are eligible. Transportation expenses to/from care Potentially Only the cost of transportation to or from where care is given (e.g. to a day camp or to an after-school program not at the school). Tuition for pre-k/nursery school Dependent care FSA: How to get paid back To get reimbursed for an expense, send a claim form to UniAccount. To download a form online, go to anthem.com/ca. If the provider signs the claim form, you don t need to send an itemized statement. If the provider doesn t sign the claim form, you ll need to send an itemized statement with your claim form. This statement should include: The date(s) of service. Be sure to sign at the bottom of the claim form. You can send your claim form and itemized statement (if needed) to UniAccount in one of two ways: Mail to: UniAccount P.O. Box 4381 Woodland Hills, CA Fax to: The dependent s name and date of birth. Itemized list of charges. The provider s name, address and Tax ID/SSN. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.