QUALIFIED FSA EXPENSES (For Health Care Flexible Spending Accounts)
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1 QUALIFIED FSA EXPENSES (For Health Care Flexible Spending Accounts) * This list is by no means exhaustive. Please consult IRS 213 for additional information, or contact MGIS directly (flexinfo@mgis.com). MEDICAL Abortion (legal) Ambulance Expenses Artificial Limbs/Prosthetics Breast Reconstruction Surgery (following a mastectomy to ameliorate a deformity related to a disease) Coinsurance & Deductibles (expenses in excess of an insurance plan s usual, customary and reasonable charges) Diagnostic Services (for medical purposes) Hospital Services (inpatient care including amounts paid for lodging and meals) Laboratory Fees Medical Services (must be legal and prescribed by a physician) Obstetrical/Gynecological Expenses Operations/Surgery Physical Exams Vasectomy/ Sterilization/ Vasectomy Reversal X-Ray Fees IN Cosmetic Expenses (must be prescribed by a physician to treat an existing illness, and not for cosmetic purposes see Cosmetic section) DENTAL Artificial Teeth Coinsurance & Deductibles (expenses in excess of an insurance plan s usual, customary reasonable charges) Dental Implants (eligible if primary purpose is to treat or correct an existing dental condition that meaningfully promotes the proper function of the body and/or is not for cosmetic reasons) Dental Treatment (including fees for X-Rays, fillings, braces, extractions, dentures, etc.) Fluoridation Device Occlusal Guards to prevent teeth grinding Orthodontia (including fees associated with maintenance work) IN Toothbrushes, Dental Floss, Tooth Paste Teeth Whitening/Bleaching (may be eligible if prescribed by a physician to treat a congenital abnormality, disfiguring disease, or treatment resulting from personal injury from an accident or trauma) Dental Implants (not eligible if the primary purpose is to improve the patient s appearance and/or if solely for cosmetic purposes)
2 VISION Contact Lenses and related materials and equipment (i.e., saline solution and cleaners) Eye Examinations, Eyeglasses and related materials and equipment (must be prescribed by a physician for medical purposes) Laser Eye Surgery (including Lasik & Radial Keratotomy) Optometrist/Ophthalmologist Expenses Over-the-Counter Eye Drops Reading Glasses Sunglasses (must be prescription and not for cosmetic purposes) Visine or Other Such Eye Drops Sunglasses (non-prescription) IN MEDICATIONS/PRESCRIPTIONS Acne Medications (Prescription or Over-the-Counter may require a physician s letter prescribing the item to treat an existing medical condition and not for cosmetic purposes) Allergy Medicines (Prescription or Over-the-Counter) Aspirin Antacids (if used to treat an existing medical condition) Birth Control Pills Calamine Lotion, Bug Bite Medication Cold Medicine (Prescription or Over-the-Counter) Cough Drops, Throat Lozenges First Aid Cream, Bactine Flu Shots Glucosamine/Chondroitin (if accompanied by a physician s letter prescribing the item to treat an existing medical condition, i.e. arthritis) Over-the-Counter Hormone Therapy & Treatment for Menopause (if accompanied by a physician s letter prescribing the item to treat an existing medical condition, i.e. hot flashes, night sweats, etc.) Immunizations (i.e., tetanus, well-baby shots, etc.) Insulin Laxatives Menstrual Cycle Products for Pain and Cramp Relief (Prescription or Overthe-Counter) Motion Sickness Pills Facial Cleansers One-a-Day Vitamins IN Nutritional Supplements, Vitamins, Herbal Supplements, Natural Medicines: unless prescribed by a physician to treat a specific medical condition or unavailable without a prescription Rogaine: if purchased over-the-counter for cosmetic purposes) Stockpiling: Medications/supplies must be used/consumed during your employer s plan year. Excessive amounts of OTC items may be deemed stockpiling and therefore ineligible for reimbursement.
3 MEDICATIONS/PRESCRIPTIONS (continued) Muscle/Joint Pain Medications (i.e. BenGay, Tiger Balm) Nasal Sprays Norplant Insertion or Removal Non-Prescription Drugs and Medicines (if used to treat an existing medical condition) Over-the-Counter Medicines (i.e., aspirin, cough medicine, etc.) used to treat an existing medical condition. Medications/supplies must be used/consumed during your employer s plan year. Excessive amounts of OTC items may be deemed stockpiling and therefore ineligible for reimbursement. Prescription Drugs (as prescribed by a physician) Sinus Medications Smoking Cessation Medicines (such as nicotine patches, nicotine gums, etc.) Sunburn Ointment or Cream (not just regular skin moisturizers) Vaccines Viagra Visine or Other Such Eye Drops Wart Remover Treatments IN MEDICAL SUPPLIES Air Purifier/Humidifier (as prescribed by a physician for a specific medical condition) Band-Aids, Bandages, Gauze Pads Blood Pressure Monitoring Devices Carpal Tunnel Wrist Supports Crutches Contraceptives (may be over-the-counter, e.g., condoms, spermicidal foams) Ear Plugs (as prescribed by a physician for a specific medical condition) Hearing Aids (including amounts paid for batteries and maintenance) Heating Pads, Cold/Hot Packs for Injuries Insulin Medical Monitoring and Testing Devices (e.g., blood pressure monitor, syringes, glucose kit, ovulation monitor, etc.) Orthopedic Shoes & Inserts (if accompanied by a physician s letter prescribing the item to treat an existing medical condition) IN Cosmetics & Toiletries (such as face creams, deodorants, hand lotions, toothpaste, etc.) Kleenex, Tissues
4 MEDICAL SUPPLIES (continued) Oxygen (including amount paid for oxygen and equipment for breathing problems associated with a medical condition) Supplies to treat a Medical Condition (e.g., bandages, gauze, batteries for hearing aids, etc. Supply must be purchased to treat a specific medical condition and not as a personal comfort item) Thermometers Wheelchair (including purchase and costs of operation and upkeep) IN PREGNANCY/FERTILITY Adoption (medical expenses incurred before adoption is finalized) Childbirth Classes (educational classes solely for instruction for child birth, not child rearing, e.g., Lamaze) Contraceptives (may be over-the-counter, e.g., condoms, spermicidal foams) Coinsurance & Deductibles (expenses associated with child birth in excess of an insurance plan s usual, customary reasonable charges) Fees for Long-Term Storage of Sperm or Embryo (for immediate conception) Fertility Treatments (including shots, treatment, surgery, GIFT, etc.) Infertility Treatments Ovulation Monitor Pre-Natal Vitamins Pregnancy Test (over-the-counter) IN Breast Pumps Diapers or Diaper Service Maternity Clothes TREATMENT/THERAPY Acupuncture (if to treat a medical condition) Alcoholism: for inpatient treatment at a therapeutic center for alcohol addiction Chiropractors Christian Science Practitioners (for medical care) Counseling for Medical Reasons (e.g. Psychiatrist, Psychologist, etc.) Drug Addiction (for inpatient treatment at a therapeutic center for drug addiction) Neuropathic, Holistic, Alternative Treatment (for medical care for the purpose of affecting any structure or function of the body) Physical Therapy Psychiatric Care Marriage Counseling IN Massage Therapy (unless prescribed by a physician to treat a specific injury or trauma)
5 TREATMENT/THERAPY (continued) Psychoanalysis Psychologist/Psychiatrist Learning Disability (amounts paid to special school or teacher, prescribed by a physician, for a child who has severe learning disabilities caused by mental or physical impairments) Smoking Cessation Programs IN COSMETIC Cosmetic Surgery (if medically necessary to correct a congenital abnormality, disfiguring disease, or corrective surgery resulting from personal injury from an accident or trauma) Cosmetic Implants (eligible if primary purpose is to treat or correct an existing condition that meaningfully promotes the proper function of the body and/or is not solely for cosmetic reasons) Botox Treatment Chapstick, Lip Balm IN Collagen Injections (for the purpose of improving the patient s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease) Cosmetic Surgery (for the purpose of improving the patient s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease) Cosmetic Implants (not eligible if the primary purpose is to improve the patient s appearance and/or if solely for cosmetic purposes) Cosmetics (such as face creams, deodorants, hand lotions, etc.) Ear Piercing Electrolysis or Hair Removal Face Lifts (unless medically necessary, see Eligible Cosmetic Surgery) Hair Transplant Schlerotheraphy Teeth Whitening/Bleaching (may be eligible if prescribed by a physician to treat a congenital abnormality, disfiguring disease, or treatment resulting from personal injury from an accident or trauma) Varicose Veins Wigs (may be eligible if prescribed by a physician for the mental health of a patient who has lost all of his or her hair due to disease or treatment) MISCELLANEOUS Automobile Modifications for Physically Handicapped Person IN Exercise Equipment or Programs (unless prescribed by a physician to treat a specific medical condition)
6 MISCELLANEOUS (continued) Guide Dog or Animal Aide (including purchase, training, and care of animals used by vision-impaired or hearing-impaired person) Nursing Services (including nurse s board, wages, or other nursing services does not include nursing service for a healthy baby) Lodging Expenses (amount paid for travel primarily for and essential to medical care up to $50.00 per night) Travel Expenses (amounts paid for transportation primarily for, and essential to medical care $0.14 per mile for 2004, $0.15 per mile for 2005) Weight Loss Programs/Drugs (must be prescribed by a physician to treat a specific medical condition, i.e., heart disease, obesity, diabetes, etc.) Warranties (for eligible medical devices/equipment) IN Fitness Programs Health Club Dues Household Help Meals (associated with travel for medical purposes) Swimming Lessons Tanning Salons & Equipment Weight Loss Programs/Drugs (for improvement of general health) Funeral Expenses
POTENTIALLY ELIGIBLE* ELIGIBLE YES
MEDICAL FLEXIBLE SPENDING ACCOUNT EXPENSES Abortion Acne Treatment Acupuncture Adaptive Equipment Alcoholism treatment Allergy medicine Alternative healers/chinese herbal Ambulance Appearance Improvements
ELIGIBLE EXPENSES. FSA Eligible & Ineligible Expenses MEDICAL/PRESCRIPTIONS DENTAL VISION
ELIGIBLE EXPENSES MEDICAL/PRESCRIPTIONS Acupuncture - if to treat a medical condition Ambulance Expenses Artificial Limbs/Prosthetics Breast Reconstruction Surgery - following a mastectomy to ameliorate
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