Download Flexible spending account expense guide

Flexible spending account
expense guide
or the UniAccount FSA
SM
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
Notes
FSA* Eligible
Acne treatments
Yes
No
Acupuncture
Yes
No
Adoption, medical expense
Potentially
No
Alcohol and drug rehab
Yes
No
Allergy medicine
Potentially
No
Prescription required.
Allergy product and home improvements to
treat severe allergies
Potentially
No
If the product would be owned without the allergy, then the
expense is not considered eligible. See Capital expenses.
Alternative healers
Potentially
No
Letter of medical necessity required.
Ambulance transport
Yes
No
Antacid
Potentially
No
Prescription required.
Antihistamine
Potentially
No
Prescription required.
Artificial limbs
Yes
No
Artificial teeth
Yes
Yes
Aspirin
Potentially
No
Bandages
Yes
No
Batteries for durable medical equipment
Yes
No
27557CAMENABC 03/12
Must be used to treat a specific medical condition.
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.
Prescription required.
Must note usage of batteries on receipt.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Birth control pills
Yes
No
Blood pressure monitoring devices
Yes
No
Blood sugar test kit and test strips
Yes
No
Body scan/diagnostic testing
Yes
No
Braille books and magazines
Potentially
No
Breast reconstruction surgery following
mastectomy
Yes
No
Burn garment
Yes
No
Capital expenses
Potentially
No
Only the amount above the cost of regular printed material is
reimbursable. Letter of medical necessity required.
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
Yes
No
Chelation (EDTA) therapy
Yes
No
Childbirth classes
Yes
No
Chiropractors
Yes
No
Christian Science practitioner
Yes
No
Circumcision
Yes
No
COBRA premiums
No
No
Coinsurance, copays and deductibles —
dental
Yes
Yes
Coinsurance, copays and deductibles —
medical
Yes
No
Coinsurance, copays and deductibles — vision
Yes
Yes
Cold medicine
Potentially
No
Cold packs
Yes
No
Condoms
Yes
No
Contact lenses, materials and equipment
Yes
Yes
Contraceptives
Yes
No
Controlled substances in violation of federal
law
No
No
Cosmetics
No
No
Only if used to treat a medical condition such as lead poisoning.
Letter of medical necessity required.
Prescription required.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Cosmetic prescriptions
No
No
CPR classes
Potentially
No
Letter of medical necessity required.
Decongestants
Potentially
No
Prescription required.
Dental visits (not cosmetic)
Yes
Yes
Cosmetic dental procedures are not eligible.
Dentures
Yes
Yes
Deodorant
No
No
Diabetic supplies
Yes
No
Diagnostic services
Yes
No
Diapers and diaper service for newborns
No
No
Diaper rash ointments and creams
Yes
No
Diarrhea medicine
Potentially
No
Prescription required.
Dietary supplements
Potentially
No
Letter of medical necessity required.
Diet foods
No
No
DNA collection and storage
No
No
Doula (birthing coach)
Potentially
No
Drug addiction treatment
Yes
No
Drug overdose, treatment of
Yes
No
Dual-purpose expenses (items that have both
a medical and general/personal/cosmetic
purpose)
Potentially
No
Durable medical equipment
Yes
No
Dyslexia
Potentially
No
Letter of medical necessity required.
Ear plugs
Potentially
No
Letter of medical necessity required.
Egg donor fees
Yes
No
Eggs and embryos storage
Yes
No
Electrolysis or hair removal
No
No
Elevator
Potentially
No
See Capital expenses.
Exercises equipment or programs
Potentially
No
Letter of medical necessity required.
Expenses reimbursed by a health
reimbursement account
No
No
Eye examination, eyeglasses, equipment and
materials
Yes
Yes
Face cream and moisturizers
No
No
Face lifts
No
No
Family counseling
Potentially
No
Feminine hygiene products
No
No
Fertility treatments
Yes
No
Fiber supplements
Potentially
No
Letter of medical necessity required.
Letter of medical necessity required.
Only temporary storage is eligible. Letter of medical necessity
required.
Not unless recommended to treat a medical disorder. Letter of
medical necessity required.
Letter of medical necessity required.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
First aid cream
Yes
No
First aid kits
Yes
No
Flu shots
Yes
No
Fluoridation devices
Yes
No
Foods
Potentially
No
Founder’s fee
No
No
Gauze pads
Yes
No
Genetic testing
Potentially
No
GIFT
Yes
No
Glucosamine
Potentially
No
Glucose monitoring equipment
Yes
No
Glucose tablets
Yes
No
Guide dog, other animal aide
Potentially
No
Hair colorants
No
No
Hair removal and transplants
No
No
Hand lotion
No
No
Health club dues and fees
No
No
Hearing aids
Yes
No
Hemorrhoid treatment
Potentially
No
Prescription required.
Herbs
Potentially
No
Letter of medical necessity required.
Hormone replacement therapy (HRT)
Potentially
No
Only if used to treat a medical condition.
Hospital services
Yes
No
Hot packs
Yes
No
Household help
No
No
Illegal operations and treatment
No
No
Immunization
Yes
No
Inclinator
Yes
No
Incontinence supplies
Yes
No
Insect bite creams and ointments
Yes
No
Insulin
Yes
No
Insurance premiums
No
No
Laboratory fees
Yes
No
Lactaid
Potentially
No
Lactation consultation
Yes
No
Lamaze classes
Yes
No
Only the portion of the class covering the birthing process is
eligible.
Language training
Potentially
No
Letter of medical necessity required.
Lasik eye surgery
Yes
Yes
Laxatives
Potentially
No
See Special foods.
If ordered for medical care.
See Dual-purpose expenses.
Letter of medical necessity required.
Prescription required.
Prescription required.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Lead-based paint removal
Potentially
No
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
No
If for a child with dyslexia or disabled child. But school fees for
regular schooling normally don’t qualify.
Lifetime care — advance payment
No
No
Liquid adhesive for small cuts
Potentially
No
Lodging at a hospital or similar institution
(patient only)
Yes
No
Lodging of a companion
Yes
No
If accompanying a patient for medical treatment.
Lodging not at a hospital or similar
institution
Yes
No
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
No
No
Marijuana or other controlled substances in
violation of federal law
No
No
Marriage counseling
No
No
Massage therapy
Potentially
No
Letter of medical necessity required.
Mastectomy-related special bras
Potentially
No
Letter of medical necessity required.
Maternity clothes
No
No
Meals at a hospital or similar institution
(patient only)
Yes
No
Meals not at a hospital or similar institution
No
No
Meals of companion
No
No
Meals; attending a medical conference
No
No
Medic Alert bracelet
Yes
No
Medicare Part B premiums
No
No
Medical conference admission
Potentially
No
Medical information plan changes
Yes
No
Medical monitoring and testing devices
Yes
No
Medical newsletter
No
No
Medical record charges
Yes
No
Medical services
Yes
No
Medicated lip balm
Yes
No
Menstrual pain relievers
Potentially
No
Motion sickness pills
Yes
No
Mouthwash
No
No
Nasal sprays
Potentially
No
Prescription required.
Nasal strips
Potentially
No
Prescription required.
Letter of medical necessity required.
Product must be listed as either medicated or having an SPF for
sun protection.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Naturopathic healers
No
No
Nebulizer
Yes
No
Nicotine gum and patches
Potentially
No
Nonprescription drugs used to treat a
specific medical condition
No
No
Nonprescription drugs used for general
health and/or cosmetic purposes
No
No
Nonprescription drugs — dual purpose
No
No
Norplant insertion or removal
Yes
No
Nursing home expenses
No
No
Nursing services provided by a nurse or other
attendant
Yes
No
Nutritionist’s professional expenses
Potentially
No
OB/GYN
Yes
No
Occlusal guards
Yes
Yes
Office visits — dental
Yes
Yes
Office visits — medical
Yes
No
Office visits — vision
Yes
Yes
Operations — dental
Yes
Yes
Legal operations only. Cosmetic procedures are not eligible.
Operations — medical
Yes
No
Legal operations only. Cosmetic procedures are not eligible.
Operations — vision
Yes
Yes
Legal operations only. Cosmetic procedures are not eligible.
Optometrist
Yes
Yes
Organ donors
Yes
No
Orthodontia
Yes
Yes
Orthopedic shoes and inserts
Yes
No
Osteopath fees
Yes
No
Over-the-counter (OTC) pregnancy test/
fertility
Potentially
No
Ovulation monitor
Potentially
No
Oxygen
Yes
No
Pain relievers
Potentially
No
Personal-only expenses
No
No
Physical exams
Yes
No
Physical therapy
Yes
No
Podiatrist
Yes
No
Pregnancy termination
Yes
No
Pregnancy test kits
Potentially
No
Prenatal vitamins
Potentially
No
Prescription drugs used to treat a specific
medical condition
Yes
No
Letter of medical necessity required.
Prescription required.
Employment-related exams are not eligible.
Legal terminations only.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Prescription drugs used for general health
and/or cosmetic purposes
No
No
Prescription drugs — dual purpose
Potentially
No
Only if used mainly to prevent or alleviate a physical or mental
defect or illness.
Prescription drugs imported from another
country
Yes
No
Prescribed by a doctor to address a medical condition.
Prescription drug discount programs
No
No
Prescription eyeglasses
Yes
Yes
Propecia
Potentially
No
Prosthesis
Yes
No
Psychiatrist
Yes
No
Psychoanalysis
Yes
No
Psychologist
Yes
No
Radial keratotomy
Yes
Yes
Reading glasses
Yes
Yes
Recliner chairs
No
No
Retin-A
Potentially
No
Reversal of tubal ligation or vasectomy
Yes
No
Rogaine
Potentially
No
Rubbing alcohol
Yes
No
Safety glasses
No
No
Sales tax on qualified medical expenses
Yes
No
School and education residential
No
No
School and education, special
Potentially
No
Screening tests — dental or vision
Yes
Yes
Screening test — medical
Yes
No
Shipping and handling fees on eligible
expenses
Yes
Yes
Sick-child facility
No
No
Sinus medications
Potentially
No
Skin moisturizer
No
No
Sleep deprivation treatment
Potentially
No
Smoking cessation
Potentially
No
Special foods
Potentially
No
Spermicidal foam
Potentially
No
Sperm storage fees
Potentially
No
Temporary storage only. Letter of medical necessity required.
St. John’s Wort
Potentially
No
Letter of medical necessity required.
Stem cell, harvesting and/or storage
Potentially
No
Letter of medical necessity required.
Only if hair loss is due to a medical condition. Letter of medical
necessity required.
Letter of medical necessity required.
Only if hair loss is due to a medical condition.
Only if recommended by a physician. Letter of medical necessity
required.
Prescription required.
Letter of medical necessity required.
Letter of medical necessity required.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Sterilization procedures
Yes
No
Student health fee
No
No
Sunglasses clips
No
No
Sunglasses (prescription)
Yes
Yes
Sunglasses (nonprescription)
No
No
Sunburn creams and ointments
Potentially
No
Sunscreen
Potentially
No
Supplies to treat a medical condition
Yes
No
Surrogate expenses
No
No
Take-home drug test
Potentially
No
Take-home pregnancy test
Yes
No
Take-home urinary tract infection test
Yes
No
Teeth whitening
No
No
Telephone for hearing impaired persons
Yes
No
Therapy
Yes
No
Thermometers
Yes
No
Throat lozenges
Potentially
No
Toiletries
No
No
Toothache and teething pain relievers
Potentially
No
Toothbrushes
No
No
Toothpaste
No
No
Transplants
Yes
No
Transportation and travel expenses for
person receiving dental care
Yes
Yes
Contact UniAccount for mileage rates.
Transportation and travel expenses for
person receiving medical care
Yes
No
Contact UniAccount for mileage rates.
Transportation and travel expenses for
person receiving vision care
Yes
Yes
Contact UniAccount for mileage rates.
Transportation of someone other than the
person receiving dental or vision care
Potentially
Potentially
Only for certain cases:
 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
person receiving medical care
Potentially
No
Only for certain cases:
 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
Yes
No
Prescription required.
Prescription required.
Expense Description
FSA Eligible
Limited
Notes
FSA* Eligible
Umbilical cord freezing and storage
Potentially
No
Vaccines
Yes
No
Varicose vein, treatment of
No
No
Vasectomy
Yes
No
Veneer
No
No
Vision discount programs
No
No
Vitamins
Potentially
No
Walker
Yes
No
Wart remover treatment
Potentially
No
Only to treat a medical condition. Prescription required.
Weight-loss programs and/or drugs
prescribed to induce weight loss
Potentially
No
Letter of medical necessity required.
Wigs
Potentially
No
Only if hair loss is due to a medical condition. Letter of medical
necessity required.
Collection and storage indefinitely “in case needed” is not
eligible for reimbursement.
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.
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 91365-4381
Fax to:
818-234-4730
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
FSA Eligible
Notes
After-school care
Yes
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
Yes
Amount paid for actual care of the dependent are eligible.
Care for a spouse or other tax dependent
who is physically or mentally incapable of
self-care
Potentially
Person must live in the participant’s home at least eight hours a day.
Care for person not residing with
participant
No
Childcare placement fees
No
Early-morning care
Yes
Field trips/activity fees
No
Lesson in lieu of care
No
Material fees
No
Unless inseparable from the cost of care.
Meals
No
Unless inseparable from the cost of care.
Nanny
Yes
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
No
Unless inseparable from the cost of care.
Expense Description
Dependent Care
FSA Eligible
Overnight camp
No
Payments to the participant’s spouse or to
the parent of the participant’s child who is
not the participant’s spouse
No
Registration fees
Potentially
School tuition for kindergarten or above
No
Sick child facility
Yes
Summer day camp
Yes
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
Yes
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.
Notes
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.
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 91365-4381
Fax to:
818-234-4730

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.