The following list is not intended to be comprehensive, but contains some of the more common medical expenses. The Internal Revenue Service deter- mines the expenses that are allowable and disallowable. IRS Publication 502, Medical and Dental Expenses, has a checklist of the medical expenses that can be deducted under the Health Care Spending Account. Eligible Health Care Expenses
The Flexible Spending Account Plan is as Easy as 1, 2, 3! 1 Elect an annual election amount based on your estimated expenses for the next Plan Year. Keep in mind that the Medical FSA and Dependent Care FSA are separate accounts, so please make your elections accordingly. 2 Your Employer will begin withholding funds from your check on a PRE-TAX basis and depositing them into your FSA account(s). 3 When you incur an expense, submit the itemized receipt to Flex Administrators, Inc. and receive reimbursement with your TAX-FREE money.
• Over-the-counter items purchased to alleviate or treat an illness or injury • Prescription drugs • Smoking Cessation Programs • Special Education for the handicapped • Sterilization Fees • Substance Addiction Treatment Ineligible • Warranty • Dates of Service outside of the Plan Year
• Acupuncture • Arch supports, knee and wrist braces • Breast Pump • Chiropractors’ fees • Co-Insurance • Co-Pays • Deductible Expenses • Dental Fees • Dentures • Dermatologist • Diabetic supplies • Eye exams • First aid supplies • Infertility Treatments • Laboratory fees • Laser eye surgery
Over-the-Counter Medications Over-the-counter items are eligible for reimbursement. The 5 most common expenses eligible without a prescription are: Pain relief medi- cations, cold and flu products, allergy products, heartburn medications and menstrual products. For more information regarding OTC product eligibility, please visit our website. Orthodontia Reimbursement Please note: Orthodontia reimbursement is based on when the service is incurred, not when payment is made. Also, all first time orthodontia requests must include the Truth in Lending Statement or treatment contract. For assistance in determining what orthodontia expenses would be eligible for reimbursement from this Plan Year please contact our office directly or reference our website for additional information. Special Foods including foods following Bariatric Surgery, Gluten-Free and Infant Formula: Eligible with Medical Necessity prescribing it to treat a specific medical condition and only to the extent that the cost of special food exceeds cost of commonly available same product. Also, it cannot be a substitute for normal nutritional requirements. Massage Therapy: Must be prescribed to treat a specific medical condition • Service Fees/Late Fees • Electric Toothbrushes • Medical Marijuana • Non-Prescription Sunglasses • Cosmetic Procedures Requires Medical Necessity Vitamins and Supplements: Must be prescribed to treat a specific medical condition and not to promote general health. Health Club Dues and Fees: Only qualify in very limited circumstances such as fees incurred upon the advice of a medical practitioner to treat a specific medical condition (e.g., rehab after back surgery or treatment for obesity). The expense must not have been incurred “but for” the disease (i.e. if you belonged to the health club before diagnosis the fees would not qualify). Fitness Tracker: Must be prescribed to treat a specific medical condition and not to promote general health. Weight Loss Treatment: Must be prescribed to treat a specific medical condition and not to promote general health. IV Vitamin Therapy (e.g., DRIPBar): Must be prescribed to treat a specific medical condition and not to promote general health.
What Kind of Medical FSA Expenses are Eligible? Qualifying health care expenses may be incurred for you, your legally married spouse, your natural child, your adopted child, a child placed with you for adoption, your step-child or your foster child through December 31 of the calendar year the child turns age 26; or other children, relatives and members of your household who are your “qualifying Child” or “qualifying relative” under IRS guide- lines. For a complete definition of Qualifying Child or Qualifying Relative, please contact our office. Your expenses must be incurred means date of service, NOT date of payment) within the plan year or prior to your employment termination date. What Do I Need to Submit in Order to Get Reimbursement? We accept the following forms of documentation for reimbursement: Explanation of Benefits form (EOB) from your insurance company. Itemized receipt from the Service Provider which includes the pro- vider’s name and address, date of service, patient name, description of service(s) and the amount of the charge. Cash Register Receipt for OTC or Prescription Expenses will be accepted as long as the name of the provider, the date of service and the description of the expense is visible on the receipt.
FSA Store Flex Administrators, Inc. has partnered with FSA Store to help you understand
the many available uses of your Flexible Spending Account. The site helps make purchasing FSA eligible items simple. You can access the store through our website at www.flexadministrators.com.
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