FSA Eligible Items
Qualifying Health Care Expenses
Health Care Expenses Not Allowed
• Acupuncture • Alcoholism • Ambulance • Annual Physical • Exam
• Flu Shots • Hearing Aids • Home Care
• Baby Sitting • Cosmetic Surgery • Dancing Lessons • Diaper Service • Electrolysis or Hair Removal • Funeral Expenses • Future Medical Care • Hair Transplant • Health Club Dues • Household Help
• Maternity Clothes • Medicine (from Outside U.S.) • Non-prescription Medicines • Nutritional Supplements • Swimming Lessons
• Hospital Services • Laboratory Fees
• Artificial Limb • Artificial Teeth • Bandages • Birth Control Pills • Blood Pressure Monitor • Body Scan • Breast Pumps & Supplies • Chiropractor • Contact Lenses • Crutches • Dental Treatment • Diabetic monitors, test kits, strips and supplies • Diagnostic Devices • Disabled Dependent Care • Drug Addiction • Eyeglasses • Eye Surgery • Fertility Enhancement • First Aid Kits
• Lactation Expenses • Menstrual products • Plan Mileage (for travel to/ from eligible healthcare) • Nursing Services • Optometrist • Osteopath • Over-the-counter drugs and medications • Oxygen • Physical Examination • Pregnancy Test Kit • Prescription Medicines • Prosthesis • Psychiatric Care • Psychologist • Saline Solution • Sterilization • Sunscreen (SPF 15+ and “Broad Spectrum”) • Surgery Telephone (Hearing Impaired)
• Teeth Whitening • Veterinary Fees • Weight-Loss Program • Food
Items That Require Physician RX
• Allergy Medication • Diaper Rash Ointments & Creams
• Over-the-counter • Weight Loss Drugs (for purpose of medical condition)
For a Complete List of Eligible Expenses, Visit www.irs.gov or www.fsastore.com
22 - Employee Benefits Guide
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