Know Your FSA/HRA Eligible and Ineligible Expenses

[Pages:2]Know Your FSA/HRA Eligible and Ineligible Expenses

Maximize the Value of Your Reimbursement Account

Your Flexible Spending Account (FSA) and/or Health Reimbursement Account (HRA) dollars can be

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used for a variety of out-of-pocket health care expenses. Take a look at the following lists for a better

understanding of what is and isn't eligible.

Note: This list is not meant to be all-inclusive, as other expenses not specifically mentioned may also qualify. For additional information, check your Summary Plan Document or contact your Plan Administrator.

Eligible Expenses

Baby/Child to Age 13 n Lactation Consultant* n Lead-Based Paint Removal n Special Formula* n Tuition: Special School/Teacher for

Disability or Learning Disability* n Well Baby Care

Dental n Dental X-Rays n Dentures and Bridges n Exams and Teeth Cleaning n Extractions and Fillings n Gum Treatment n Oral Surgery n Orthodontia and Braces

Eyes n Artificial Eyes n Eyeglasses and Contact Lenses n Laser Eye Surgeries n Prescription Sunglasses n Radial Keratotomy/LASIK

Hearing n Hearing Devices and Batteries n Hearing Examinations

Lab Exams/Tests n Blood Tests and Metabolism Tests n Body Scans n Cardiographs n Laboratory Fees n Urine and Stool Analyses n X-Rays

Medical Equipment/Supplies n Abdominal and Back Supports* n Air Purification Equipment* n Arches and Orthopedic Shoes n Contraceptive Devices n Crutches and Wheel Chairs n Exercise Equipment* n Hospital Beds n Mattresses* n Medic Alert Bracelet or Necklace n Nebulizers n Oxygen* n Post-Mastectomy Clothing n Prosthesis n Splints/Casts or Support Hose* n Syringes n Wigs*

Medical Procedures/Services n Acupuncture n Alcohol and Drug Addiction

(inpatient and outpatient treatment) n Ambulance n Hospital Services n Infertility Treatment n In Vitro Fertilization n Norplant Insertion or Removal n Physical Examination

(not employment-related) n Reconstructive Surgery (due to a

congenital defect or accident) n Service Animals* n Sterilization/Sterilization Reversal n Transplants (including organ donor) n Transportation* n Vaccinations and Immunizations

Medication n Birth Control n Homeopathic Medications* n Insulin n Prescription Drugs n Weight Loss Drugs*

Obstetrics n Lamaze Class n Midwife Expenses n OB/GYN Exams n OB/GYN Prepaid Maternity Fees

(reimbursable after date of birth) n Pre- and Postnatal Treatments

Practitioners n Allergist n Chiropractor n Christian Science Practitioner n Dermatologist n Homeopath or Naturopath* n Osteopath n Physician n Psychiatrist or Psychologist

Therapy n Alcohol and Drug Addiction n Counseling (not marital or career) n Exercise* n Hypnosis n Massage* n Occupational n Physical n Speech n Weight Loss Programs*

Note: Expenses marked with an asterisk (*) are "potentially eligible expenses" that require a Note of Medical Necessity from your health care provider to qualify for reimbursement.

Know Your FSA/HRA Eligible and Ineligible Expenses

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The IRS does not allow the following expenses to be reimbursed under FSAs or HRAs, as they are not prescribed by a physician for a specific ailment.

Ineligible Expenses

n Baby-sitting and Child Care* n Contact Lens or Eyeglass

Insurance n Cosmetic Surgery/Procedures n Dancing/Exercise/Fitness

Programs* n Diaper Service

n Electrolysis n Personal Trainer n Hair Loss Medication n Hair Transplant n Health Club Dues* n Insurance Premiums and Interest n Long-Term Care Premiums

n Marriage Counseling n Maternity Clothes n Sunscreen n Swimming Lessons n Teeth Bleaching or Whitening n Vitamins or Nutritional

Supplements*

Note: This list is not meant to be all-inclusive. Also, expenses marked with an asterisk (*) are "potentially eligible expenses" that require a Note of Medical Necessity from your health care provider to qualify for reimbursement.

The IRS allows certain over-the-counter (OTC) items to be reimbursed using your FSA/HRA dollars. Here is a brief listing of some of those items:

This document is confidential to Evolution BenefitsTM, Inc. and may not be used, copied or disclosed except with express prior written consent of Evolution Benefits, Inc. Evolution Benefits makes no warranties, expressed or implied in connection with its content. Copyright ? 2010 Evolution Benefits, Inc., all rights reserved. Evolution Benefits and Benny are registered service marks of Evolution Benefits, Inc. Business processes protected under US Patents 7,174,302, 7,197,468 and 7,680,679 with additional patents pending.

Eligible Over-the-Counter Items

Note: Product categories are listed in bold face, common examples of products are listed in regular face.

Items in these categories can be purchased with a prepaid benefits card and without a prescription

n Acne Medications Clearasil, OXY

n Antifungal (foot) Lamisil, Lotrimin

n Antiseptics, Wound Cleansers Alcohol, peroxide, Epsom salt, Betadine

n Baby Electrolytes Pedialyte, Enfalyte

n Baby Teething Pain Baby Orajel, Anbesol Baby Oral Gel

n Contraceptives/Family Planning n Denture Adhesives, Repair, Pain

Relief and Cleansers PoliGrip, Benzodent, Efferdent n Diabetes Testing and Aids Insulin, Ascencia, One Touch, Diabetic Tussin, insulin syringes; glucose products n Diagnostic Products Thermometers, blood pressure monitors, cholesterol testing n Ear Care Ear drops, syringes, ear wax removal; Debrox, Similasin n Elastics/Athletic Treatments ACE, Futuro, elastic bandages, braces, hot/cold therapy, orthopedic supports, rib belts n Eye Care Contact lens care, Visine, Refresh Tears

n Family Planning Pregnancy and ovulation kits

n Fiber Laxatives Benefiber, Fibercon, Metamucil

n First Aid Burn Remedies Dermoplast, Solarcaine

n First Aid Dressings and Supplies Band Aid, 3M Nexcare, non-sport tapes

n Foot Care Treatments Corn and callus treatments, wart removers, devices, therapeutic insoles

n Glucosamine and/or Chondroitin (arthritis treatment) Osteo-Bi-Flex, Cosamin D, Flex-a-min

n Hearing Aid/Medical Batteries n Homeopathic Remedies

(products that treat an illness or condition) Boiron and Hyland products n Incontinence Products Attends, Depend, GoodNites for juvenile incontinence, Prevail, Calmoseptine n Nasal Sprays, Drops and Inhalers Afrin Spray, Ocean Nasal Spray n Oral Remedies or Treatments Mouth sore treatments, dental repair, Salivart, Anbesol, Orajel, Dentemp

n Prenatal Vitamins Stuart Prenatal, Nature's Bounty prenatal Vitamins

n Reading Glasses and Maintenance Accessories

n Skin Treatments (for eczema, psoriasis, rosacea, etc) Psoriasin, MG217, Dermarest Eczema

n Smoking Deterrents Nicoderm, Nicorette

Categories that require a prescription and cannot be purchased using a card

n Acid Controllers n Allergy and Sinus medicine n Antibiotics n Anti-Diarrheals n Anti-Gas Products n Anti-Itch and Insect Bite n Anti-Parasitic Treatments n Cough, Cold and Flu n Digestive Aids n Feminine Anti-Fungal/Anti-Itch n Hemorrhoidal Preps n Laxatives n Motion Sickness n Pain Relievers n Respiratory Treatments n Sleep Aids and Sedatives n Stomach Remedies

Note: This list is our best interpretation of eligible items. The definitive list will be available on December 15, 2010. We will update this document as soon as that list is issued. Check your Plan Administrator's web site for more information as it becomes available.

For additional information, please contact your Plan Administrator.

CHC-010 101810

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