Health FSA

Eligible Reimbursements

Health FSA

Section 125 Calculator

FSA Expense Worksheet

What Expenses Are Eligible for Reimbursement?

The following table illustrates expenses commonly requested for reimbursement from the Health FSA (Unreimbursed Medical Expense Account) or HSA. This tool is for use by American Fidelity Assurance Company customers and any other use is strictly prohibited. Each item, service, or charge in this table is classified as an eligible expense, potentially eligible expense, or not an eligible expense.

Eligible Expense = eligible for reimbursement under a Health FSA, HRA, or a tax-free distribution from an HSA.
Potentially Eligible Expense = sometimes qualifies as eligible depending upon certain facts.
Generally Not an Eligible Expense = does not typically qualify as an eligible expense, although a limited exception is available.
Not An Eligible Expense = does not qualify as an eligible expense for reimbursement under a Health FSA, HRA, or a tax-free distribution from an HSA.
OTC = over-the-counter

American Fidelity does not reimburse capital expenses, even though they may be qualified expenses. Examples of capital expenses include, but are not limited to, exercise equipment, removal of lead-based paint, air conditioner, air purifier, mattresses, pillows or vacuums, water filters, automobile modifications for physically handicapped individuals, home improvements such as exit ramps, widening doorways, etc. to accommodate physically handicapped individuals.

Eligible
Potentially Eligible
Not Eligible

Eligible Expense
Expense	Eligible	Special Rules
Acupuncture	Yes	If treating a medical condition.
Adoption – medical expenses incurred before adoption is finalized	Yes	If the child is your tax dependent when the service is provided.
Alcoholism treatment	Yes	For inpatient treatment
Ambulance	Yes
Artificial limbs and teeth	Yes
Asthma treatments	Yes
Bandages (OTC)	Yes
Blood pressure monitoring devices	Yes
Blood sugar test kit and test strips (OTC)	Yes	Diagnostic items
Body scan	Yes	See Diagnostic items/services
Breast pumps and lactation supplies, excluding breastfeeding bras (OTC)	Yes
Breast reconstruction surgery following mastectomy	Yes	Eligible if surgery was done following a mastectomy for cancer.
Carpal tunnel wrist supports	Yes
Chelation therapy	Yes	Eligible expense if used to treat a medical condition such as lead poisoning.
Chiropractors	Yes
Circumcision	Yes
Cold/hot packs (OTC)	Yes
Condoms (OTC)	Yes
Co-insurance amounts, co-payments and deductibles	Yes	Eligible if the underlying service/item qualifies.
Contact lenses, materials, and equipment	Yes	If contacts are needed for medical purposes. Supplies needed for using lenses will qualify if the lenses are needed for medical purposes.
Cosmetic procedures or surgery	Generally no	Exception for amounts paid for surgery necessary to improve a deformity arising from a congenital abnormality, personal injury from an accident or trauma, or a disfiguring disease.
Crutches	Yes
Deductibles	Yes
Dental services	Yes	Eligible for expenses incurred for the prevention and alleviation of dental disease. Teeth whitening is not eligible.
Dentures and denture adhesives (OTC)	Yes
Diabetic supplies (OTC)	Yes	Diagnostic items
Diagnostic item/services	Yes
Drug addiction treatment	Yes
Drug overdose treatment	Yes
Egg donor fees	Yes
Eye examinations, eyeglasses and related equipment and materials/cleaners	Yes
Flu shots	Yes
Gauze pads (OTC)	Yes
Glucose monitoring equipment (OTC)	Yes	Diagnostic items
Guide dog or other animal aide	Yes	Eligible if expense is to assist a physically disabled person; expense of buying, training, and maintaining a guide dog includes the expenses of food and innoculations. Veterinary fees for such animals also qualify as medical care.
Hearing aids (OTC)	Yes	Includes the cost of batteries
Hemorrhoid treatment (OTC)	Yes	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Hospital services	Yes
Immunizations	Yes
Incontinence supplies (OTC)	Yes	Adult diapers used to relieve incontinence generally will qualify. See Diapers.
Insulin	Yes	Includes equipment necessary to inject the insulin, such as syringes or insulin pumps.
Laboratory fees	Yes	If part of medical care or diagnosis.
Laser eye surgery/Lasik/Radial Keratotomy	Yes
Liquid bandage (OTC)	Yes
Mastectomy-related bras	Yes
Medical monitoring and testing devices (OTC)	Yes	These items include blood-pressure monitors, syringes, glucose kit, etc.
Medical records charges	Yes	For the expense associated with transferring medical records to a new medical practitioner.
Medicines and drugs	Yes	See Drugs and medicines
Norplant insertion or removal	Yes
Obstetrical expenses	Yes
Occlusal guards to prevent teeth grinding	Yes
Optometrist	Yes
Organ donor	Yes	Including surgical, hospital and laboratory services as well as transportation expense for donor.
Orthodontia expenses	Yes	Orthodontia expenses and supplies are eligible. However, when an orthodontic treatment plan is paid up-front at the time of the first visit, the plan may apportion the reimbursements as services are provided during the treatment plan.
Ovulation monitor	Yes
Physical exams	Yes
Physical therapy	Yes
Pregnancy test kit	Yes
Prenatal expenses	Yes	Prenatal expenses paid up front may be reimbursed in the year during which the lump sum amount was contracted, despite the fact that all expenses have not yet been incurred.
Prosthesis	Yes
Psychiatric care	Yes	Eligible if treating a medical condition. Must submit a medical practitioner's recommendation stating the expense is to treat a specific medical condition, an EOB, or a practitioner's receipt listing the diagnosis code.
Radial keratotomy	Yes
Screening tests	Yes	Must be used for medical diagnosis.
Seeing-eye dog	Yes	See Guide dog.
Sinus medication (OTC)	Yes	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Smoking cessation (stop-smoking) programs	Yes
Sterilization procedures	Yes
Supplies to treat medical condition (OTC)	Yes	Eligible if the medical supply is used to diagnose or treat a specific medical condition and is not a personal comfort item.
Taxes on medical services and products	Yes	Eligible expense to the extent imposed on reimbursable medical care or products.
Telephone equipment for hearing impaired-person	Yes	Expense of buying and repairing special telephone equipment for hearing-impaired person.
Television equipment for hearing-impaired person	Yes	Eligible expense for the equipment that displays the audio part of television programs as subtitles for hearing-impaired individuals. Eligible reimbursement is limited to the cost that exceeds cost of regular item.
Thermometers (OTC)	Yes
Transplants	Yes	Eligible expenses include surgical, hospital and laboratory services and transportation expenses for donors.
Transportation expenses for person to receive medical care	Yes	Eligible expense if travel is primarily for, and essential to, medical care. Includes car and rental car expenses; parking and tolls. The 2012 standard medical travel mileage rate is 23¢ per mile. Effective January 1, 2013, the standard medical travel mileage rate is 24¢ per mile.
Transportation expenses for someone other than the person receiving medical care	Yes	Transportation costs of an individual (such as a family member) traveling with the individual receiving medical care will qualify as eligible expenses if the presence of the family member on the trip was indispensable to enable the individual to obtain care, such as a parent traveling with a child or a nurse or other person who gives injections, medication, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone. In addition, an individual who travels to visit a mentally ill dependent, if such visits are recommended as part of treatment.
Vasectomy/vasectomy reversal	Yes
Viagra	Yes	Eligible expense if prescribed by a physician to treat a medical condition. See Drugs and medicine.
Walkers	Yes
Wheelchair	Yes
X-ray fee	Yes	Eligible if received for medical reasons.

Potentially Eligible
Expense	Eligible	Special Rules
Acne treatment (OTC)	Potentially eligible	If to treat acne, it is eligible if incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines. However, the cost of regular skin care does not qualify.
Acne treatment - prescription	Potentially eligible	If the expense can be used for both cosmetic and medical (such as Retin-A, which can be used to treat both acne and wrinkles), a physicians recommendation with the medical condition is required.
Allergy medicine (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Alternative healers	Potentially eligible	Nontraditional healing treatments provided by professionals may be eligible if provided to treat a specific medical condition. The treatments must be legal. And the expenses do not qualify if the remedy is a food or substitute for food that the person would normally consume in order to meet nutritional requirements. Drugs and medicines recommended by alternative healers to treat a specific medical condition can qualify as medical care. Drugs and medicines incurred after December 31, 2010 must be prescribed. See Drugs and medicines.
Analgesics (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Antacid (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Antihistamine (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Anti-itch creams (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Antibiotic sprays or ointments (for first aid) (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Aspirin (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Behavioral modification programs	Potentially eligible	See Schools and education
Birth control pills	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Birthing classes/childbirth classes/Lamaze	Potentially eligible	Expenses for a coach, doula or significant other are not eligible. See Lamaze classes.
Calamine lotion (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Childbirth classes	Potentially eligible	Expenses for a coach, doula or significant other are not eligible. See Lamaze classes.
Chondroitin (OTC)	Potentially eligible	Eligible if used primarily for medical care. Will not qualify if used to maintain general health. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
Christian Science practitioners	Potentially eligible	Eligible if expense is for medical care.
Cold medicine (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Contraceptives (OTC)	Potentially eligible	See birth control pills; condoms; Spermicidal foam.
Cough suppressants (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Counseling	Potentially eligible	Eligible if primarily for medical care. Must submit a medical practitioner's recommendation with the medical condition, an EOB, or a practitioner's receipt listing the diagnosis code.
Decongestants (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Diaper rash ointment/cream (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Diarrhea medicine (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Dietary supplements (OTC)	Potentially eligible	Eligible if used primarily for medical care. Will not qualify if used to maintain general health. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
DNA collection and storage	Potentially eligible	Temporary storage may be eligible if collected as part of a diagnosis, treatment or prevention of existing or imminent medical condition. A medical practitioner's recommendation with the medical condition is required.
Drugs and medicines	Potentially eligible	Must be primarily for medical care (and not for personal, general health, or cosmetic purposes), legally procured, and generally accepted as medicines and drugs. In addition, over-the-counter expenses incurred after December 31, 2010, will qualify only if the medicine or drug is prescribed or is insulin. A prescription for this purpose is one written by an individual legally licensed to issue prescriptions, meeting the same legal requirements and including the same information as required for a drug or medicine that is available by prescription only. The prescription must be submitted with the expense reimbursement request but the prescription does not have to be filled by a pharmacist.
Ear plugs (OTC)	Potentially eligible	Eligible if treating a specific medical condition. A medical practitioner's recommendation with the medical condition is required.
Eggs and embryos storage fees	Potentially eligible	Eligible if expense is for temporary storage, but only to the extent necessary for immediate conception.
Fertility treatments (e.g., surgery, in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) and shots)	Potentially eligible	Eligible to the extent procedure is intended to overcome an inability to have children. Expenses for IVF surrogate not eligible unless the surrogate is a tax dependent.
Fever reducing medications (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Fiber supplements (OTC)	Potentially eligible	Eligible if used primarily for medical care. Will not qualify if used to maintain general health. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
First aid cream and first aid kits (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Fitness programs	Potentially eligible	See health club dues.
Gambling addiction treatment	Potentially eligible	Expense eligible for inpatient treatment at a therapeutic center for gambling addiction.
Genetic testing	Potentially eligible	Eligible if testing is done to diagnose a medical condition or to determine possible defects. However, testing done just to determine the sex of a fetus would not qualify.
Glucosamine (OTC)	Potentially eligible	Eligible if used primarily for medical care. Will not qualify if used to maintain general health. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
Herbal supplements (OTC)	Potentially eligible	See Dietary supplements
Home care	Potentially eligible	See Nursing services
Hormone replacement therapy	Potentially eligible	Eligible if expense is primarily for medical care. Will not qualify if used to maintain general health. Prior to January 1, 2011, a medical practitioner's recommendation is required. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Infertility treatments	Potentially eligible	See Fertility treatments.
Insect bite creams and ointments (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Lamaze class	Potentially eligible	To the extent instruction relates to birth and not childrearing. Expenses for the coach or significant other do not qualify.
Language training for dyslexic/disabled child	Potentially eligible	Eligible if the expense is for a child with dyslexia or an otherwise disabled child. Amounts paid for regular schooling do not qualify. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Laxatives (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Learning disability, instructional fees	Potentially eligible	Eligible if expense is prescribed by a physician. Includes expenses for special school or specially trained teacher for a child who has severe learning disability caused by mental or physical impairment.
Lodging at hospital or similar institution	Potentially eligible	Eligible if principle reason for being there is to receive medical care.
Lodging *not* at hospital or similar institution	Potentially eligible	Up to $50/night, provided: (1) lodging is primarily for and essential to medical care; (2) medical care is provided in a hospital or medical facility related to or equivalent to licensed hospital; (3) lodging is not lavish; and (4) no element of personal pleasure, recreation or vacation in the travel. If a parent is traveling with a sick child, up to $100 may qualify ($50 for each person).
Lodging of a companion	Potentially eligible	If accompanying a patient for medical reasons and all of the conditions described under Lodging not at a hospital, are also met.
Massage therapy	Potentially eligible	Eligible if expense is to treat a specific injury or trauma. Will not qualify if to improve general health. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Medic-alert bracelet/necklace (OTC)	Potentially eligible	Eligible if expense is recommended by a medical practitioner in connection with treating a medical condition. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Medical conference admission/transportation/meals	Potentially eligible	Eligible if expense relates to a chronic disease suffered by you, your spouse, or your dependent and if the conference is primarily for and essential to the person in need of medical care.
Menstrual pain relievers (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Mentally handicapped, special home for	Potentially eligible	The cost of keeping a mentally handicapped person in a special home (not a relative's home) on a psychiatrist's recommendation to help that person adjust from life in a mental hospital to community living may apply.
Motion sickness pills (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Nasal sprays (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Nasal strips (OTC)	Potentially eligible	Eligible if expense is incurred to treat medical condition. Will not qualify if used for run of the mill snoring. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Naturopathic healers	Potentially eligible	See Alternative healers; Drugs and medicines; Vitamins
Nicotine gum or patches (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Nursing services provided by a nurse or other attendant	Potentially eligible	Expenses incurred, such as wages, employment taxes, and other amounts you pay for nursing services (including extra costs for nurses' room and board) generally will qualify, whether provided in the participant's home or another facility. The attendant doesn't have to be a nurse, as long as the services are those generally performed by a nurse. These include services connected with caring for the patient's condition, such as giving medication or changing dressings, as well as bathing and grooming. But if the person providing nursing services also provides household and personal services only those expenses for nursing services qualify.
Nutritionist's professional expenses	Potentially eligible	Eligible if expense relates to a specifically diagnosed medical condition. Will not qualify if the expense is for general health. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition
Nutritional supplements (OTC)	Potentially eligible	See Dietary supplements.
Over-the-counter medicines (OTC)	Potentially eligible	See Drugs and medicines.
Pain relievers (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Patterning exercises	Potentially eligible	Eligible if expense is for exercises for a mentally handicapped child. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition
Prenatal vitamins (OTC)	Potentially eligible	If taken during pregnancy (a medical condition). Vitamins taken at other times generally do not qualify. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition
Propecia	Potentially eligible	Eligible if used to treat a medical condition such as alopecia. When used for cosmetic purposes (i.e., to treat male pattern baldness) it is not an eligible expense. Must be prescribed. See Drugs and medicines.
Psychoanalysis or psychologist	Potentially eligible	Eligible if expense is treating a medical condition. Will not qualify if for the general improvement of mental health, to relieve stress or personal enjoyment. Must submit a medical practitioner's recommendation stating the expense is to treat a specific medical condition, an EOB, or a practitioner's receipt listing the diagnosis code.
Retin-A	Potentially eligible	Eligible if expense is treating a medical condition. Will not qualify if purchased for cosmetic purposes (for example, to reduce wrinkles), even if recommended by a medical practitioner. Prior to January 1, 2011, a medical practitioner's recommendation is required stating the expense is to treat a specific medical condition. Must be prescribed if incurred after December 31, 2010. See Acne treatment; Cosmetic procedures and Drugs and medicines.
Rogaine	Potentially eligible	Eligible if expense is treating a medical condition. Will not qualify if purchased for cosmetic purposes even if recommended by a medical practitioner. Prior to January 1, 2011, a medical practitioner's recommendation is required stating the expense is to treat a specific medical condition. Must be prescribed if incurred after December 31, 2010. See Propecia and Drugs and medicines.
Schools and education, residential	Potentially eligible	Eligible if expense is to treat an individual for behavioral, emotional, or addictive conditions (tuition, meals, and lodging) and the principal reason for attending the program is to receive medical care. If a child is at a school because the courses and disciplinary methods have a beneficial effect on the child's attitude, the expenses won't qualify. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Schools and education, special	Potentially eligible	Eligible if expense is to treat an individual who is mentally impaired or physically disabled to attend a special school (tuition, meals, and lodging) and the principal reason for attending the school is to overcome or alleviate the disability. This includes teaching Braille to a visually impaired person, teaching lip reading to a hearing-impaired person, and remedial language training to correct a condition caused by a birth defect. If a child is at a school because the courses and disciplinary methods have a beneficial effect on the child's attitude, the expenses won't qualify. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Sleep deprivation treatment	Potentially eligible	Eligible expense if the person is under the care of a medical practitioner. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Spermicidal foam (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Sperm, storage fees	Potentially eligible	Eligible if expense is for temporary storage, but only to the extent necessary for immediate conception.
St. John's Wort (OTC)	Potentially eligible	Eligible if used primarily for medical care. Will not qualify if used to maintain general health. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
Stem cell, harvesting and/or storage of	Potentially eligible	Eligible if there is a specific and imminent medical condition that the stem cells are intended to treat. But collection and storage indefinitely, just in case an item might be needed, is not medical care. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
Sunglasses	Potentially eligible	Prescription sunglasses would qualify.
Sunscreen with high SPF (OTC)	Potentially eligible	Potentially eligible if SPF is 30 or higher and used to alleviate a specific medical condition. Would also qualify if used by a person who has or has had skin cancer or another diagnosed skin disease that is affected by sun exposure. Does not include tanning lotions, make-up or moisturizers, etc., that contain a lower dose of SPF. Prior to January 1, 2011, a medical practitioner's recommendation is required stating the item is to treat a specific medical condition. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Throat lozenges (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Toothache and teething pain relievers (OTC)	Potentially eligible	Eligible if expense incurred prior to January 1, 2011. Must be prescribed if incurred after December 31, 2010. See Drugs and medicines.
Transportation to and from medical conference	Potentially eligible	See Medical conference admission, transportation, meals, etc.
Umbilical cord blood storage	Potentially eligible	Eligible expense if there is an existing or imminently probable disease that the umbilical cord blood is intended to treat, such a newborn who has a birth defect and the cord blood would be needed in the near future. Collection and storage as a precaution to treat a disease or condition that might possibly develop in the future is not medical care.
Vitamins (OTC)	Potentially eligible	Eligible if used primarily for medical care. Will not qualify if used to maintain general health. A medical practitioner's recommendation is required stating the item is to treat a specific medical condition.
Weight-loss programs and/or drugs prescribed to induce weight loss	Potentially eligible	Eligible expense if a physician recommends to treat a specific medical condition (such as obesity, heart disease, or diabetes). Will not qualify if only to improve general health. The costs of food associated with a weight-loss program would not qualify. Prior to January 1, 2011, a medical practitioner's recommendation is required stating the expense is to treat a specific medical condition. Drugs and medicines must be prescribed if incurred after December 31, 2010. See Drugs and medicines.

Not Eligible
Expense	Eligible	Special Rules
Advanced reimbursements	No	See special requirements under Orthodontia expenses and Prenatal expenses.
Autopsy	No
Babysitting/child care	No	See Dependent daycare expenses.
COBRA premiums	Generally no	Health FSA – Not eligible HRA – Not eligible HSA – Eligible expense
Cosmetic procedures or surgery	Generally no	Exception for amounts paid for surgery necessary to improve a deformity arising from a congenital abnormality, personal injury from an accident or trauma, or a disfiguring disease.
Cosmetics	No
Dependent daycare expenses	No	Dependent day care expenses are not eligible medical expenses but may be eligible for reimbursement from a Dependent Day Care FSA
Diapers or diaper service	Generally no	Eligible if expenses incurred to relieve the effects of a diagnosed medical condition, such as urinary incontinence in adults. A medical practitioner's recommendation with the medical condition is required.
Electrolysis or hair removal	No
Face creams, moisturizers (OTC)	No
Face lifts	No
Feminine hygiene products	No
Funeral expenses	No
Hair removal/transplant	No
Health club dues and fees	Generally no	Only in very limited circumstances would fees paid to a health club qualify. Expense is eligible if a physician recommends to treat a specific medical condition (e.g., rehabilitation after back surgery or treatment for obesity). The expense must not have been incurred "but for" the disease (for example, if you belonged to the health club before being diagnosed, then the fees would not qualify). When treatment is no longer needed, the fees would no longer qualify. A medical practitioner's recommendation is required stating the expense is to treat a specific medical condition.
Illegal operations and treatments	No
Insurance premiums	Generally no	FSA – no. For HRA depending on plan design, insurance premiums may be eligible. HSAs can reimburse insurance premiums in limited circumstances. See information at www.irs.gov for more details.
Late fees on medical bills	No
Lodging while attending a medical conference	No
Long term care services	Generally no	FSA – No HRA – No HSA - Yes
Marijuana or other controlled substances	No
Missed appointment fee	No
Nursing services for a baby	No	Does not qualify if baby is normal and healthy.
Physician access retainer	No
Prescription drugs and medicines obtained from other countries	No
Prescription drug discount programs	No	A fee paid to get a drug discount card will not qualify; the cost of the prescription may qualify.
Safety glasses	Generally no	Eligible if prescription lenses.
Suntan lotion/clothing to block sun	No
Surrogate expenses	No
Teeth whitening/bleaching	No
Toothbrushes or toothpaste (OTC)	No	Not eligible even if recommended by dentist to treat medical condition.
Veneers	No

ESB-734-1211

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