Download Healthcare Eligible Expense Listing

Healthcare
Eligible Expense Listing
This list has been compiled for the convenience of our clients and participants and is designed to provide a general overview. Readers
are cautioned to review their own employer-sponsored benefit plan descriptions and enrollment material for specific information or to
consult with their employer or personal tax advisor as necessary. This information is subject to change at any time and without notice.
Eligible medical care expenses include amounts paid for the diagnosis, cure, mitigation, treatment or prevention of disease, and for
treatments affecting any part or function of the body. The expenses must be primarily to alleviate or prevent a physical or mental defect
or illness. Expenses solely for cosmetic reasons are not generally expenses for medical care and may not be eligible. Expenses that
are merely beneficial to one's general health are not expenses for medical care. In some cases, participants may be asked to provide a
letter of medical necessity from your attending physician to substantiate their claim.
IMPORTANT:
Effective January 1, 2011, over-the-counter (OTC) medicines and drugs will require a written prescription (Rx) from your doctor in order to get
reimbursed. Please keep this federal requirement in mind when using your healthcare account for expenses incurred on or after January 1, 2011. Items
marked with (Rx Required) require a prescription as of January 1, 2011.
Acne treatment, includes over-thecounter acne medications; excludes
cost of regular skin care (Rx required –
see notice above)
Acupuncture
Alcoholism treatment
Allergy treatments (Rx required for
OTC drugs – see notice above)
Antacids (Rx required – see notice
above)
Artificial insemination
Artificial limb/teeth
Automobile modifications (if medically
necessary)
Battery-powered toothbrush (if
medically necessary and prescribed by
physician)
Birth control prescriptions
Blood pressure monitoring devices
Bone density testing
Braille books and magazines (excess
of amount paid over cost of regular
printed editions) bought for visually
impaired person
Breast pumps and supplies that assist
lactation
Childbirth expenses (physician,
midwife
Childbirth preparation classes
(excludes portion of mother’s coach,
feeding and newborn care)
Chiropractor professional fees
Cholesterol testing
Christian Science Practitioner fees
Circumcision
Co-insurance, co-pay amounts and
deductibles
Cold Medicine (Rx required – see
notice above)
Computer data bank fees, medical
history
Condoms
Contact lenses and cleaning solutions
Crutches
Deductibles
Dental treatment (includes exams, xrays, fillings, root canals, gum disease
treatment, crowns, bridges, dentures,
implants, sealants, extractions,
orthodontia; does not include cosmetic
treatments such as teeth whitening,
dental veneers, bonding, etc.)
Dental veneers (for non-cosmetic
reasons)
Diabetic supplies (insulin, syringes,
testing strips, glucometers)
Diagnostic services and tests
Diapers (if required due to medical
condition)
Drug dependency treatments
Dyslexia treatment
Genetic testing
Guide dog or other animal used to
assist persons with physical disabilities
Gynecologists’ fees
Health institute
Health screening
Hearing aids and batteries
Home health care
Home medical equipment
Hospital services
Immunizations
In vitro fertilization
Inclinator
Infertility treatments
Insulin and syringes
Laboratory fees
Fertility exams
Lamaze classes (see childbirth
classes)
Language training for child with
dyslexia or disabled child
Laser eye surgery
Lead-based paint removal
Learning disability caused by mental or
physical impairment, or nervous
system disorders (treatment must be
recommended by physician - see
IRSPublication502 - Learning
Disability)
Legal fees (fees you pay that are
necessary to authorize treatment for
mental illness)
Long-term care services
Fertility treatments
First Aid Kit
Flu shots
Fluoridation device (if medically
necessary & prescribed by physician)
Mastectomy-related special bras (the
cost over & above the cost of a normal
bra)
Medic-alert bracelet
Egg donor charges for recipient
Eye surgery (cataract, LASIK, corneal
rings, etc.)
Eyeglasses, prescription (includes
prescription sunglasses; also includes
over-the-counter reading glasses)
Eye examinations
Medical equipment (crutches,
wheelchairs, walkers)
Medical records charges
Medical Supplies (bandages,
thermometers, hot/cold packs, nasal
(breathe-right) strips, etc.)
Medicines/Drugs (prescription drugs,
see Over-the-counter Drugs/Medicines
with a prescription, insulin; does not
include cosmetic drugs)
Mentally handicapped, special home
for person adjusting from life in mental
institution to community living
Mileage or fares related specifically to
an eligible medical visit to and from
healthcare providers, hospitals and
pharmacies. Effective July 1, 2011,
the mileage rate for the use of a car
(also vans, pickups or panel trucks),
for eligible medical visits is $.235 per
mile. Before July 1, 2011, the rate was
$.19 per mile. The mileage rate for
travel that occurred between 1/1/11
and 6/30/11 will remain at $.19 per
mile. Actual fares for buses, taxis,
trains and subways are reimbursable
for the full cost
Norplant insertion and removal
Nursing home (if necessary for
medical care and only the portion for
medical services)
Nursing services
Nutritionist’s professional expenses (if
treating a specific medical condition;
not for weight loss for general health)
Obstetrical expenses
Occlusal guards to prevent teeth
grinding
Occupational therapy
Optometrist fees
Oral surgery
Organ donation fees
Orthodontia
Orthopedic devices
Orthopedic shoes (to the extent the
cost exceeds that of normal shoes)
Osteopath fees
Over-the-counter Drugs/Medicines
(Rx required – see notice above)
*This includes but is not limited to
allergy medicines, antacids, antidiarrhea, anti-fungal ointments and
creams, antiseptic ointments and
creams, cold medicines including sore
throat sprays, lozenges, nasal sprays,
cough syrups, cough drops, vapor
rubs, eye drops, first-aid and antibiotic
creams and ointments, gas relief
medicines, hemorrhoid ointments and
creams, laxatives, lice treatments,
motion-sickness pills, pain relievers
including arthritis pain, head/back pain
and menstrual pain, sleep aids, stop
smoking gums/patches, yeast infection
products. (Note: Cosmetic items,
vitamins, herbal and dietary
supplements or items for general good
health are not considered OTC
drugs/medicines and are not eligible
even with a prescription.)
Over-the-counter items (such as
crutches, bandages, OTC eyeglasses)
Ovulation monitor
Oxygen equipment
Pain Relievers (Rx required – see
notice above)
Physical exams, routine physicals
Physical therapy
Physicians’ fees
Pregnancy test, over-the-counter
Prescription drugs (for non-cosmetic
reasons)
Prescription eyeglasses/sunglasses
Prosthesis
Psychiatrists’ fees (for medical
reasons)
Psychologists’ fees (for medical
reasons)
Psychotherapists’ fees (for medical
reasons)
Psychoanalysis
Psychologist fees
Radial keratotomy/Ortho keratology
Reading glasses (prescription glasses
or OTC glasses)
Reconstructive surgery following
mastectomy
Reverse vasectomy
Routine physicals
Schools and education, special (for
mentally impaired or physically
disabled person - see
IRSPublication502)
Sick-child care facility (for medical care
only)
Sleep disorder and treatment
Speech therapy
Sterilization procedures (vasectomy or
tubal ligation)
Stop-smoking programs (including
hypnosis, over-the-counter gums and
patches will require a prescription) (Rx
required – see notice above)
Storage fees for embryo or sperm
(fees for temporary storage of eggs or
sperm only to extent used for
immediate conception in current plan
year)
Storage fees for umbilical cord blood
(fees for temporary storage only to
extent used for medical condition in
current plan year)
Substance abuse treatment
Sunglasses (only if medically required
due to specific medical condition &
obtained at direction of physician)
Surgical fees (for legal operations not
cosmetic in nature)
Taxes charged for medical services
and products
Telephone consultations with a health
care provider
Telephone or Television for hearingimpaired persons, special equipment
Therapy, physical or speech
Transplants (donor expenses, if you
pay those expenses)
Transportation including mileage, fare
for bus, taxi, train, plane and related
travel expenses for person seeking
treatment (See 'Mileage' and
IRSPublication502 - Transportation
and Trips)
Vaccines, vaccinations
Vasectomy
Vitamins (only if necessary to treat a
specific medical condition) and
accompanied with a Letter of Medical
Necessity)
Walkers
Weight-loss program (only if medically
necessary to treat existing disease,
such as heart disease, and undertaken
under physician’s direction)
Wheelchair
Wigs (if purchased upon advice of
physician for mental health of patient)
X-ray fees
Healthcare
Ineligible Expense Listing
This list has been compiled for the convenience of our clients and participants and is designed to provide a general overview. Readers
are cautioned to review their own employer-sponsored benefit plan descriptions and enrollment material for specific information or to
consult with their employer or personal tax advisor as necessary. This information is subject to change at any time and without notice.
IMPORTANT:
Starting January 1, 2011, certain over-the-counter (OTC) medicines and drugs will be considered ineligible expenses unless you have a written
prescription from your doctor. Please keep this federal requirement in mind when you decide how much money you will put into your healthcare account.
Adoption Fees
Baby-Sitting, childcare or nursing
services for a healthy baby
Boutique practice fees, retainer fees,
concierge fees
Expenses not incurred during your
period of coverage
Facelifts or other similar cosmetic
treatments (dermabrasion, chemical
peels, etc.)
Funeral expenses
“No Show” charges for doctor or
dentist visits
Nursing services for healthy baby
Nutrition supplements
Hair transplant
Paternity testing
Health club membership dues
Herbal supplements (dietary and
nutritional supplements, vitamins,
natural medicines, ect.)
Household help
Physical therapy treatments for
general well-being
Childbirth preparation classes (portion
that pertains to mother’s coach,
feeding and newborn care)
Completing claim forms, fees for
Controlled substances
Cord Blood Collection (can be
reimbursed if there is a specific
medical condition that the cord blood is
intended to treat)
Cosmetic surgery or procedures;
cosmetic prescription drugs such as
Retin-A, Renove, Propecia, etc and
cosmetics that contain acne fighting
ingredients
Counseling (marriage, family)
Dancing lessons
Dental veneers or bonding
Diaper service
Divorce expenses
Domestic help
Doula services
Medical newsletters
Medical savings account
Illegal operations and treatments
Insurance premiums
Lactation consultant for general
instruction
Laetrile
Lamaze/Childbirth classes-see
Childbirth preparation classes
Late payment fees
Lens replacement insurance
Lifetime care fees
Liposuction or other similar cosmetic
treatments
Safety glasses
Storage fees for embryo, sperm or
umbilical cord blood, long term
Student health fees
Sun screen lotion
Sunglasses, clip on
Surrogate expenses
Swimming lessons
Tanning salons and equipment
Tattoo removal
Teeth bleaching/whitening for cosmetic
purposes
Temporary Continuation of Coverage
(TCC) premiums
Union dues
Marriage, family counseling
Ear piercing
Electrolysis or hair removal
Exercise equipment for general health
Exercise/Fitness programs for general
health
Expenses reimbursed elsewhere or
that may be reimbursable under any
other source
Massage therapy (unless
recommended as medically necessary
to treat a specific injury or illness; does
not include therapy for stress or
tension reduction)
Marijuana
Maternity clothes
Mattress
Meals while traveling to obtain medical
care
Vacuum cleaner for allergies
Varicose veins, treatment of
Vision discount programs
Vision service agreements or lens
replacement insurance
Weight loss programs for general
health or appearance; diet foods for
weight loss
Dependent Care
Eligible Expense Listing
This list has been compiled for the convenience of our clients and participants and is designed to provide a general overview. Readers
are cautioned to review their own employer-sponsored benefit plan descriptions and enrollment material for specific information or to
consult with their employer or personal tax advisor as necessary. This information is subject to change at any time without notice.
Au pair expenses for dependent care (does not include travel
expenses)
Late pick-up fees
Looking for work-expenses incurred to enable employee to
look for work
Baby-Sitter inside or outside household
Nanny expenses
Custodial childcare or eldercare expenses for qualifying
individual
Day camps, if primary reason for being there is the care and
well-being of the child and is custodial in nature, and not
educational.
Daycare centers
FICA and FUTA taxes of daycare provider
Preschool/Nursery school for pre-kindergarten
Sick-child care center to extent the care is not for medical
services
Summer day camps
Temporary Absence such as for vacation or minor illness and
required to pay provider weekly or monthly and the payment
includes the short absence as well as work days
Household employee whose services include care of qualifying
person
Work-related day care expenses- must allow you to work or
look for work. You must be gainfully employed (earning
income). This does not include volunteer work that is unpaid or
for nominal pay.
Dependent Care
Ineligible Expense Listing
This list has been compiled for the convenience of our clients and participants and is designed to provide a general overview. Readers
are cautioned to review their own employer-sponsored benefit plan descriptions and enrollment material for specific information or to
consult with their employer or personal tax advisor as necessary. This information is subject to change at any time without notice.
Educational/ tuition expenses- kindergarten, first grade and
above
Expenses paid to child of participant
Field trip expenses
Household services (chauffeur, bartender, gardener)
Incidental expenses (diaper, activities, ect. charges)
Overnight camp (not even the portion attributed to the daytime
cost)
Payments for care where you are not the custodial parent (in
divorce situations)
Payments for care while you are off work because you are on a
leave of absence
Payments for care while you are off work because you are on
maternity or other medical leave
Payments for care while you are off work because you are on
vacation unless required to pay weekly or monthly and the
payment includes the short absence as well as work days
Payment for care while you are off work because you are on
vacation unless required to pay weekly or monthly and the
payment includes the short absence as well as work days
Payment for services not yet provided (advance payments)
Registration fees/reservation fees/holding fees unless paid in
order to obtain care and only if and when that provider is
selected
Transportation expenses unless furnished by the care provider
to or from a place where care is provided
Over-the-counter
Eligible Expense Listing
This list has been compiled for the convenience of our clients and participants and is designed to provide a general overview. Readers
are cautioned to review their own employer-sponsored benefit plan descriptions and enrollment material for specific information or to
consult with their employer or personal tax advisor as necessary. This information is subject to change at any time without notice.
*The products listed here are examples, and do NOT constitute an endorsement or an exhaustive listing of reimbursable OTC products.
IMPORTANT: Starting January 1, 2011, over-the-counter (OTC) medicines and drugs will require a written prescription (Rx) from your doctor in order to
be reimbursed. The items in this listing will require a prescription unless otherwise noted. Please keep this federal requirement in mind when using your
healthcare account for expenses incurred on or after January 1, 2011.
Notice: The items marked with a “no Rx required” are considered to be OTC supplies (NOT OTC drugs or medicines) and do not require a prescription
in order to be reimbursed.
Abreva
Ace wraps (no Rx required – see notice
above)
Acne Free
Acnomel
Actifed
Advil
Advil Cold & Sinus
Advil Migraine
Afrin Nose Drops
Afrinol
Alavert
Aleve
Aleve Cold & Sinus
Alka Seltzer
Allerest
Aloe Vera
Anbesol
Antiseptics
Anusol
Aspirin
Athlete’s foot products
Axid
Bacitracin
Bactine
Balmax
Bandages (no Rx required – see notice
above)
Bayer
Benadryl
Ben Gay
Benylin
Betadine
Breast pumps and supplies that assist
lactation (no Rx required – see notice
above)
Bronitin Mist
Bronkaid
Bronkolixer
Bunion, blister and corn treatments
(non-medicated do not require Rx - see
notice above)
Bye Bye Blemish
Caladryl
Calamine Lotion
Caldecort
Callous removers (non-medicated) (no
Rx required – see notice above)
Cepacol (sore throat spray, drops,
lozenges)
Children’s Advil Cold
Children’s Tylenol
Chloraseptic
Chlortrimeton
Claritin
Clean & Clear
Cleaning & soaking solutions for
contacts (no Rx required – see notice
above)
Clear Cough
Clear Eyes
Clearisil
Colace
Cold-Eeze
Cold/Hot packs for injuries (no Rx
required – see notice above)
Commit (Smoking Cessation)
Compound-W
Condoms (no Rx required – see notice
above)
Congestac
Contac
Coricidin D
Cortaid
Cortizone Cream
Cough Drops
Cystex
DairyCare
Dairy Relief
DayQuil
Desitin
Desinex
Dimetane
Dimetapp
Diurex
Dr. Scholl’s Clear Away (wart remover)
Dramamine
Dristan
Drixoral
Dulcolax
Eardrops
Ear wax removal
Ecotrin
Excedrin
Ex-Lax
Eye drops
Eye patches (no Rx required – see
notice above)
Femstat 3
Fleets Prep Kit
Flexall
Gas-X
Gynelotrimin
Halls Defense
Hemorrhoid Ointment
Herpecin
Hydrocortisone
Ibuprofin
Immodium
Infant Tylenol
Ipecac
Ivy Block
Joint supports (ankle, elbow, knee,
wrist) (no Rx required – see notice
above)
Kaopectate
Lactaid
Lacteeze
Lactrase
Lamisil
Lanacane
Lanacort
Lens storage cases (no Rx required –
see notice above)
Liquid adhesives (no Rx required – see
notice above)
Liquid Corn and Callous Removers
Lotrimin
Lozenges
Maalox
Marezine
Micatin
Midol
Milk of Magnesia
Mobigesic
Mobisyl
Monistat
Motrin
Motrin Migraine
Mucinex
Murad Acne Complex Kit
Mycelex-7
Mylanta
Mylicon
MyoRx
Naphcon-A
Naprosyn
Naproxen
Nasal Spray
Nasalcrom
Nature’s Cure Acne Treatment
Neosporin
Neosynephrine Drops / Spray
Nicoderm CQ
Nicorette
Nicotrol
Nicodin
Nix
NyQuil
Nytol
Ocu Hist
Orajel
Otrivin
Ovulation predictor kits (no Rx required
– see notice above)
OXY
Pamprin
Pediacare
Pedialyte
Pepcid AC
Pepto Bismal
Percogesic
Peroxide
Pin-X
Poligrip (no Rx required – see notice
above)
Polysporin
Pregnancy tests (no Rx required – see
notice above)
Premysyn PMS
Preparation H
Prilosec
Primatene
Proactiv Solution
Reading glasses (no Rx required – see
notice above)
Releev
Ricola
Rid
Robitussin brochures
Rubbing alcohol
Senokot
Sinutab
SinuCleanse
Spermicides
Splints (no Rx required – see notice
above)
Stri-Dex
Sudafed Sinus
Sudafed Tabs
Sunburn relief
Sunscreen with SPF 30 or higher
Tagamet HB
Tavist
Thera Flu
Thermometer (no Rx required – see
notice above)
Triaminic
Triple antibiotic ointment
Tronolane
Tums
Tylenol
Tylenol Cold & Flu
Uristat
Vagistat
Vicks 44
Vicks Pediatric
Vicks Sinex
Vicks Vapor Inhaler
Vicks Vapor Rub
Visine
Wart-Off
Witch Hazel
Zantac 75
ZAPZYT Acne Treatment
Zicam
Over-the-counter
Ineligible Expense Listing
This list has been compiled for the convenience of our clients and participants and is designed to provide a general overview. Readers
are cautioned to review their own employer-sponsored benefit plan descriptions and enrollment material for specific information or to
consult with their employer or personal tax advisor as necessary. This information is subject to change at any time without notice.
*The products listed here are examples, and do NOT constitute an endorsement or an exhaustive listing of reimbursable OTC products.
IMPORTANT: Effective January 1, 2011, over-the-counter (OTC) medicines and drugs will require a written prescription (Rx) from your doctor. Please
keep this federal requirement in mind when you decide how much money you will put into your healthcare account.
Body sprays
Hair removal
Chapstick
Make-up
Moisturizers
Mouthwash
Creams
Vitamins (without a letter of medical
necessity)
Dental Floss
Deodorant
Perfumes
Ear plugs
Shampoo
Soaps
Face soaps
Teeth whitening kits
Toothbrushes
Toothpaste