FSA Expenses All over-the-counter (OTC) medications and drugs must be prescribed by a physician to be eligible for reimbursement. This change was effective January 1, 2011, regardless of your plan year. IMPORTANT: The following is a list of common medical, dental and vision related items and services. Crosby determines "" based on IRS guidance. Crosby's interpretation is subject to change without notice. This list is intended only as a general guideline because all submitted expenses will be reviewed on a case-by-case basis based on the documentation provided. *In most cases, a Dual Purpose item will require a medical practitioner note to verify medical necessity. A medical practitioner note may be written by a doctor of medicine, dentistry, podiatry, optometry, an authorized chiropractor, an alternative healer or other qualified medical practitioner and must contain the following: 1. date; 2. patient s name; 3. medical practitioner s name; 4. statement of medical necessity; 5. the prescribed treatment; and 6. the duration of treatment required. Item Example/Notations? OTC Medicine or Abortion Acne Treatment Acupuncture Adoption, Pre-Adoption Medical Expenses Proactive, Stridex, Clean & Clear Air Conditioner Air Purifier Alcoholism Treatment Allergy Relief Alternative Dietary Substitutes Alternative Drugs & Medicines Alternative Healers Ambulance Analgesics Antacids & Heartburn Relief Antibiotic Creams & Ointments, Hemorrhoid Preparations Oral Medications, Nasal Sprays & Patches Aspirin, Acetaminophen, Ibuprofen Alka-Seltzer, Mylanta, Milk of Magnesia Preparation H, Bacitraycin, Neosporin Dual purpose* Dual purpose* Anti-Diarrheal Imodium, Pepto-Bismol Anti-Itch & Hydrocortisone Creams Benadryl, Caladryl, Cortaid Arthritis Pain-Relief Capzasin, Activon Artificial Limbs
FSA Expenses Item Example/Notations? OTC Medicine or Artificial Teeth Asthma Treatments Rx required if over-the-counter Automobile Modifications Babysitting & Child Care Not Bandages Elastic, Gauze Pads, Band Aids Behavioral Modification Programs Birth Control Pills Birthing Classes Blood Pressure Monitoring Devices Blood Sugar Test Kits & Test Strips Body Scans Braille Books & Magazines Breast Pumps Breast Reconstruction Surgery Following Mastectomy Calamine Lotion Prescription Required Capital Expenses Carpal Tunnel Wrist Supports Cervical Pillow Chelation Therapy Chiropractors Chondroitin/Glucosamine Christian Science Practitioners Circumcision Co-Insurance Amounts Cold Medicines Tablets, Syrups, Drops, Lozenges Cold/Hot Packs Condoms Contact Lenses, Materials & Equipment Co-Payments Cosmetic Procedures Cosmetics Counseling Crowns, Dental Crutches Makeup, Lipstick, Cotton Swabs, Cotton Balls, Baby Oil Marriage and couples counseling are ineligible Not Not Dual purpose*
FSA Expenses Item Example/Notations? OTC Medicine or Dancing & Swimming Lessons Deductibles Dental Care Toothache Relief, Temporary Filling, Denture Adhesives Dental Floss, picks, brushes Not Dental Sealants Dental Treatments Denture Care Cleaners Not Dependent Care Expenses Not Diabetic Supplies Diagnostic Items & Services Diaper Rash Creams A&D Ointment, Desinex Diapers Not Diarrhea Medicine Imodium, Kaopectate Diet Food Not Dietary Supplements Disabled Dependent Care Expenses DNA Collection & Storage Doulah Not Drug Addiction Treatment Drug Overdose Treatment Dyslexia Ear Care Ear Drops, Ear Wax Removal Ear Plugs Egg Donor Fees Eggs & Embryos Storage Fees Electrolysis or Hair Removal Not Exercise Equipment or Programs Eye Care Contact Lens Lubricating Drops, Contact Lens Solution, Eye Patches, Reading Glasses Eye Examinations Face Creams Not Face Lifts Not Family Planning Condoms, Contraceptive Creams, Pregnancy Test, Ovulation Predictor Kits
FSA Expenses Item Example/Notations? OTC Medicine or Feminine Care Feminine Hygiene Products Fertility Treatments Fiber Supplements First Aid Progesterone Cream, Estrogen Cream Tampons, Pads, Feminine Washes Heat Wraps, Hot/Cold Packs, Compresses, Bandages, Tape, Gauze Dressing, Adhesive Pads, Band-Aids Not First Aid Kits Flu Shots Fluoridation Device or Services Foot Care - Non-Medicines and Drugs Arch & Insole Supports Foot Care - OTC Medicines and Drugs Athlete's Foot Treatment, Nail & Foot Antifungal creams Founder's Fee Funeral Expenses Gambling Problem Treatment Genetic Testing Glucose monitoring equipment Guide Dog: Other Aid Animals Hair Care Color, Shampoo, Conditioner, Brushes, Hair-Loss Products, i.e. Rogaine Not Not Not Hair removal & Transplants Not Hand Lotion Not Health Club Fees Health Institute Fees Hearing Aids & Its Batteries Hemorrhoid Treatments Home Care Home Diagnostic Tests or Kits Blood pressure, cholesterol, diabetes, colorectal, HIV, urine test, thermometers Home Improvements Exit Ramps, Widening Doorways Homeopathic Medicines Hormone Replacement Therapy
FSA Expenses Item Example/Notations? OTC Medicine or Hospital Services Household Help Humidifier Illegal Operations, Treatments, Drugs Immunizations Inclinator Incontinence Supplies Infertility Treatments Insulin Joint-Support Bandages & Hosiery For example Depends and Serenity Pads Not Not Laboratory Fees Lactation Consultant Lactation Supplies Lamaze Classes For mother only. Expenses for the coach or significant other do not qualify. Language Training Laser Eye Surgery LASIK Late Fees For late payment of bills for Not medical services Laxatives Metamucil Lead-Based Paint Removal Learning Disability Instructional Fees Legal Fees, General Lodging at a Hospital or Similar Institution Lodging Not at a Hospital or Similar Institution Up to $50 per night if used primarily for and essential to medical care provided by a physician in a licensed hospital or medical care facility and there is no element of personal pleasure recreation or vacation in the travel
FSA Expenses Item Example/Notations? OTC Medicine or Lodging of a Companion Lodging While Attending a Medical Conference Marriage Counseling Massage Therapy Mastectomy-Related Special Bras Maternity Clothes Mattresses Meals at a Hospital or Similar Institution Meals Not at a Hospital or Similar Institution Meals of Companion Meals; Attending a Medical Conference Medical Alert Bracelet or Necklace Medical Conference Admission, Transportation, Meals Medical Information Plan Charges Medical Monitoring & Testing Devices Will qualify if accompanying a patient for medical reason and all of the following conditions apply: up to $50 per night if used primarily for and essential to medical care provided by a physician in a licensed hospital or medical care facility and there is no element of personal pleasure recreation or vacation in the travel Craniosacral Therapy, Myofacial Release Not Not Not Not Not Not Not Dual Purpose Medical Newsletter Not Medical Records Charges Menstrual Pain Relievers For example, Midol Mileage for Medical Appointment Expenses for Transportation Primarily for & Essential to Medical Care Mineral Supplements Dual Purpose
FSA Expenses Item Example/Notations? OTC Medicine or Missed Appointment Fees Not Morning After Contraceptive Pills Motion Sickness Treatment Dramamine, Patches, Bracelets, Bonine Mouthwash Not Nail Care & Personal Grooming Items Scissors, Nail Files, Nail Polish Not Nasal Strips or Sprays Nursing Services Provided By A Nurse or Other Attendant Wages, employment taxes and other amounts paid for nursing services generally will qualify. If person is providing household and personal services, these do not qualify. Nutritional & Dietary Supplements Bars, Milkshakes, Power drinks Occlusal Guards to Prevent Teeth Grinding Operations Optometrist Organ Donors/Transplants Orthodontia Orthopedic Shoes & Inserts Osteopath Fees Ovulation Monitor Oxygen Patterning Exercises Personal Hygiene Personal Trainer Fees Physical Exams Physical Therapy Pregnancy Test Kits Prenatal Vitamins Pre-Payment Psychiatric Care Psychoanalysis Psychologist Deodorant, Soap, Body Powder, Shaving Cream, Razors, Feminine Care, Sanitary Products if taken during pregnancy Not Not
FSA Expenses Item Example/Notations? OTC Medicine or Radial Keratotomy Retin-A For Treatment of Acne Rolfing Routine Dental Care Toothpaste, Toothbrush, Not Electric Toothbrush, Floss, Mouthwash Including Antibacterial Mouthwash & Fluoride Rinse, Breath Strips, Teeth-Whitening Rubber Gloves Rubbing Alcohol Safety Glasses Prescription Only Screening Tests Shampoo Treatments Relating to Treatment of Lice A200, Rid Shipping & Handling Fees Skin Care Skin & Body Moisturizing Not Lotion, Lip Balm Sleep Aids Tylenol PM, Sominex, Unisom Sleep Deprivation Treatment Smoking Cessation Medications Smoking Cessation Programs Special Education Schools Special Home for Mentally Handicapped Nicoderm, Nicorrett, Nicotine Gum, Smoking Cessation Patches Sperm, Storage Fees Spermicidal Foam Stem Cell Harvesting & Storage Sterilization Procedures Stomach/Digestive Relief Pepto-Bismol, Imodium, Colace, Lactaid Student Health Fees Not Sun Glasses Prescription Lenses Only Sun Screen Sunburn Creams & Ointments Solarcaine
FSA Expenses Item Example/Notations? OTC Medicine or Supplements Surrogate Expenses Taxes on Medical Services & Products Teeth Whitening Telephone for Hearing-Impaired Persons Television for Hearing-Impaired Persons Not Not Therapy Thermometers Toiletries Moisturizers, Toothpaste, Lotions, Antiperspirant, Lip Balm, Perfume, Cologne Not Tooth & Mouth Pain Relief Oragel, Anbesol Treadmill Tuition For Special Needs Program Ultrasounds Umbilical Cord, Freezing & Storage Urinary Pain Relief Vaginal Infection Treatment Monistat Vaporizers Varicose Veins Treatment Vasectomy Vasectomy Reversal Veneers Not Viagra Vision Discount Programs Not Vitamins Walkers Wart Removal Medication Compound W Weight Loss Programs and/or Drugs Prescribed to Induce Weight Loss Wheelchair Wigs X-ray fees