FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com
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FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 All over-the-counter (OTC) medications and drugs must be prescribed by a physician to be eligible for reimbursement. This change was effective January 1, 2011, regardless of your plan year. IMPORTANT: The following is a list of common medical, dental and vision related items and services. Crosby determines "Eligible" based on IRS guidance. Crosby's interpretation is subject to change without notice. This list is intended only as a general guideline because all submitted expenses will be reviewed on a case-by-case basis based on the documentation provided. *In most cases, a Dual Purpose item will require a medical practitioner note to verify medical necessity. A medical practitioner note may be written by a doctor of medicine, dentistry, podiatry, optometry, an authorized chiropractor, an alternative healer or other qualified medical practitioner and must contain the following: 1. date; 2. patient’s name; 3. medical practitioner’s name; 4. statement of medical necessity; 5. the prescribed treatment; and 6. the duration of treatment required. Item Abortion Acne Treatment Example/Notations Proactive, Stridex, Clean & Clear Eligible? Eligible Eligible OTC Medicine or Drug Requiring physician's prescription Yes, Rx Required Acupuncture Adoption, Pre-Adoption Medical Expenses Eligible Eligible Air Conditioner Air Purifier Alcoholism Treatment Allergy Relief Dual purpose* Dual purpose* Eligible Eligible Yes, Rx Required Dual Purpose* Dual Purpose* Dual Purpose* Eligible Eligible Yes, Rx Required Eligible Yes, Rx Required Eligible Yes, Rx Required Eligible Eligible Yes, Rx Required Yes, Rx Required Eligible Eligible Yes, Rx Required Alternative Dietary Substitutes Alternative Drugs & Medicines Alternative Healers Ambulance Analgesics Antacids & Heartburn Relief Antibiotic Creams & Ointments, Hemorrhoid Preparations Anti-Diarrheal Anti-Itch & Hydrocortisone Creams Arthritis Pain-Relief Artificial Limbs Oral Medications, Nasal Sprays & Patches Aspirin, Acetaminophen, Ibuprofen Alka-Seltzer, Mylanta, Milk of Magnesia Preparation H, Bacitraycin, Neosporin Imodium, Pepto-Bismol Benadryl, Caladryl, Cortaid Capzasin, Activon FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Artificial Teeth Asthma Treatments Automobile Modifications Babysitting & Child Care Bandages Behavioral Modification Programs Birth Control Pills Birthing Classes Blood Pressure Monitoring Devices Example/Notations Rx required if over-the-counter Elastic, Gauze Pads, Band Aids Eligible? Eligible Eligible Dual Purpose* Not Eligible Eligible Dual Purpose* Eligible Dual Purpose* Eligible Blood Sugar Test Kits & Test Strips Eligible Body Scans Braille Books & Magazines Breast Pumps Breast Reconstruction Surgery Following Mastectomy Eligible Eligible Eligible Eligible Calamine Lotion Capital Expenses Carpal Tunnel Wrist Supports Cervical Pillow Chelation Therapy Chiropractors Chondroitin/Glucosamine Christian Science Practitioners Circumcision Co-Insurance Amounts Cold Medicines Prescription Required Tablets, Syrups, Drops, Lozenges Eligible Dual Purpose* Eligible Dual Purpose* Eligible Eligible Dual Purpose* Dual Purpose* Eligible Eligible Eligible Cold/Hot Packs Condoms Contact Lenses, Materials & Equipment Dual Purpose* Eligible Eligible Co-Payments Cosmetic Procedures Cosmetics Eligible Not Eligible Not Eligible Counseling Crowns, Dental Crutches Makeup, Lipstick, Cotton Swabs, Cotton Balls, Baby Oil Marriage and couples counseling are ineligible Dual purpose* Eligible Eligible OTC Medicine or Drug Requiring physician's prescription Yes, Rx Required Yes, Rx Required Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Dancing & Swimming Lessons Deductibles Dental Care Dental Floss, picks, brushes Dental Sealants Dental Treatments Denture Care Dependent Care Expenses Diabetic Supplies Diagnostic Items & Services Diaper Rash Creams Diapers Diarrhea Medicine Diet Food Dietary Supplements Disabled Dependent Care Expenses DNA Collection & Storage Doulah Drug Addiction Treatment Drug Overdose Treatment Dyslexia Ear Care Ear Plugs Egg Donor Fees Eggs & Embryos Storage Fees Electrolysis or Hair Removal Exercise Equipment or Programs Eye Care Example/Notations Toothache Relief, Temporary Filling, Denture Adhesives Cleaners A&D Ointment, Desinex Imodium, Kaopectate Ear Drops, Ear Wax Removal Contact Lens Lubricating Drops, Contact Lens Solution, Eye Patches, Reading Glasses Eye Examinations Face Creams Face Lifts Family Planning Eligible? Dual Purpose* Eligible Eligible Not Eligible Eligible Eligible Not Eligible Not Eligible Eligible Eligible Eligible Not Eligible Eligible Not Eligible Dual Purpose* Dual Purpose* Dual Purpose* Not Eligible Eligible Eligible Dual Purpose* Eligible Dual Purpose* Eligible Dual Purpose* Not Eligible Dual Purpose* Eligible Eligible Not Eligible Not Eligible Eligible Condoms, Contraceptive Creams, Pregnancy Test, Ovulation Predictor Kits OTC Medicine or Drug Requiring physician's prescription Yes, Rx Required Yes, Rx Required Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Example/Notations Eligible? Feminine Care Progesterone Cream, Estrogen Cream Tampons, Pads, Feminine Washes Eligible Feminine Hygiene Products Fertility Treatments Fiber Supplements First Aid First Aid Kits Flu Shots Fluoridation Device or Services Foot Care - Non-Medicines and Drugs Foot Care - OTC Medicines and Drugs Founder's Fee Funeral Expenses Gambling Problem Treatment Genetic Testing Glucose monitoring equipment Guide Dog: Other Aid Animals Hair Care Hair removal & Transplants Hand Lotion Health Club Fees Health Institute Fees Hearing Aids & Its Batteries Hemorrhoid Treatments Home Care Home Diagnostic Tests or Kits Home Improvements Homeopathic Medicines Hormone Replacement Therapy Hospital Services Compresses, Bandages, Tape, Gauze Dressing, Adhesive Pads, Band-Aids Arch & Insole Supports Athlete's Foot Treatment, Nail & Foot Antifungal creams Color, Shampoo, Conditioner, Brushes, Hair-Loss Products, i.e. Rogaine Blood pressure, cholesterol, diabetes, colorectal, HIV, urine test, thermometers Exit Ramps, Widening Doorways OTC Medicine or Drug Requiring physician's prescription Not Eligible Eligible Dual Purpose* Eligible Eligible Eligible Eligible Eligible Yes, Rx Required Eligible Yes, Rx Required Not Eligible Not Eligible Dual Purpose* Dual Purpose* Eligible Eligible Not Eligible Not Eligible Not Eligible Dual Purpose* Dual Purpose* Eligible Eligible Dual Purpose* Eligible Yes, Rx Required Dual Purpose* Dual Purpose* Dual Purpose* Eligible Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Example/Notations Eligible? Household Help Humidifier Illegal Operations, Treatments, Drugs Not Eligible Dual Purpose* Not Eligible Immunizations Inclinator Incontinence Supplies Eligible Dual Purpose* Eligible For example Depends and Serenity Pads Infertility Treatments Insulin Joint-Support Bandages & Hosiery Eligible Eligible Dual Purpose* Laboratory Fees Lactation Consultant Lactation Supplies Lamaze Classes Eligible Dual Purpose* Eligible Dual Purpose* Language Training Laser Eye Surgery Late Fees Laxatives Lead-Based Paint Removal Learning Disability Instructional Fees For mother only. Expenses for the coach or significant other do not qualify. LASIK For late payment of bills for medical services Metamucil Legal Fees, General Lodging at a Hospital or Similar Institution Lodging Not at a Hospital or Similar Institution Dual Purpose* Eligible Not Eligible Eligible Dual Purpose* Eligible Dual Purpose* Eligible Up to $50 per night if used primarily for and essential to medical care provided by a physician in a licensed hospital or medical care facility and there is no element of personal pleasure recreation or vacation in the travel OTC Medicine or Drug Requiring physician's prescription Dual Purpose* Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Example/Notations Eligible? Lodging of a Companion Will qualify if accompanying a patient for medical reason and all of the following conditions apply: up to $50 per night if used primarily for and essential to medical care provided by a physician in a licensed hospital or medical care facility and there is no element of personal pleasure recreation or vacation in the travel Dual Purpose* Lodging While Attending a Medical Conference Marriage Counseling Massage Therapy Not Eligible Craniosacral Therapy, Myofacial Release Not Eligible Dual Purpose* Mastectomy-Related Special Bras Eligible Maternity Clothes Mattresses Meals at a Hospital or Similar Institution Not Eligible Not Eligible Eligible Meals Not at a Hospital or Similar Institution Not Eligible Meals of Companion Meals; Attending a Medical Conference Not Eligible Not Eligible Medical Alert Bracelet or Necklace Eligible Medical Conference Admission, Transportation, Meals Medical Information Plan Charges Medical Monitoring & Testing Devices Dual Purpose Medical Newsletter Medical Records Charges Menstrual Pain Relievers Mileage for Medical Appointment Not Eligible Eligible Eligible Eligible Mineral Supplements OTC Medicine or Drug Requiring physician's prescription Eligible Eligible For example, Midol Expenses for Transportation Primarily for & Essential to Medical Care Dual Purpose Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Missed Appointment Fees Morning After Contraceptive Pills Motion Sickness Treatment Mouthwash Nail Care & Personal Grooming Items Nasal Strips or Sprays Nursing Services Provided By A Nurse or Other Attendant Nutritional & Dietary Supplements Example/Notations Dramamine, Patches, Bracelets, Bonine Scissors, Nail Files, Nail Polish Wages, employment taxes and other amounts paid for nursing services generally will qualify. If person is providing household and personal services, these do not qualify. Bars, Milkshakes, Power drinks Eligible? Not Eligible Eligible Eligible Not Eligible Not Eligible Dual Purpose* Dual Purpose* Dual Purpose* Occlusal Guards to Prevent Teeth Grinding Eligible Operations Optometrist Organ Donors/Transplants Orthodontia Orthopedic Shoes & Inserts Osteopath Fees Ovulation Monitor Oxygen Patterning Exercises Personal Hygiene Eligible Eligible Eligible Eligible Dual Purpose* Eligible Eligible Eligible Eligible Not Eligible Personal Trainer Fees Physical Exams Physical Therapy Pregnancy Test Kits Prenatal Vitamins Pre-Payment Psychiatric Care Psychoanalysis Psychologist Deodorant, Soap, Body Powder, Shaving Cream, Razors, Feminine Care, Sanitary Products Eligible if taken during pregnancy Dual Purpose* Eligible Eligible Eligible Eligible Not Eligible Eligible Dual Purpose* Dual Purpose* OTC Medicine or Drug Requiring physician's prescription Yes, Rx Required Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Example/Notations Eligible? Radial Keratotomy Retin-A For Treatment of Acne Eligible Dual Purpose* Rolfing® Routine Dental Care Rubber Gloves Rubbing Alcohol Safety Glasses Screening Tests Shampoo Treatments Relating to Treatment of Lice Shipping & Handling Fees Skin Care Sleep Aids Sleep Deprivation Treatment Smoking Cessation Medications Dual Purpose* Toothpaste, Toothbrush, Electric Toothbrush, Floss, Mouthwash Including Antibacterial Mouthwash & Fluoride Rinse, Breath Strips, Teeth-Whitening Prescription Only A200, Rid Skin & Body Moisturizing Lotion, Lip Balm Tylenol PM, Sominex, Unisom Nicoderm, Nicorrett, Nicotine Gum, Smoking Cessation Patches Not Eligible Dual Purpose* Eligible Dual Purpose* Eligible Eligible Eligible Yes, Rx Required Eligible Eligible Yes, Rx Required Eligible Dual Purpose* Dual Purpose* Sperm, Storage Fees Spermicidal Foam Stem Cell Harvesting & Storage Sterilization Procedures Stomach/Digestive Relief Dual Purpose* Eligible Dual Purpose* Eligible Eligible Pepto-Bismol, Imodium, Colace, Lactaid Prescription Lenses Only Solarcaine Yes, Rx Required Eligible Not Eligible Smoking Cessation Programs Special Education Schools Special Home for Mentally Handicapped Student Health Fees Sun Glasses Sun Screen Sunburn Creams & Ointments OTC Medicine or Drug Requiring physician's prescription Not Eligible Eligible Eligible Eligible Yes, Rx Required Yes, Rx Required Yes, Rx Required Yes, Rx Required FSA Eligible Expenses Crosby Benefit Systems www.crosbybenefits.com v04302015 Item Example/Notations Eligible? Supplements Surrogate Expenses Taxes on Medical Services & Products Dual Purpose* Not Eligible Eligible Teeth Whitening Telephone for Hearing-Impaired Persons Not Eligible Eligible Television for Hearing-Impaired Persons Eligible Therapy Thermometers Toiletries Eligible Eligible Not Eligible Tooth & Mouth Pain Relief Treadmill Tuition For Special Needs Program Moisturizers, Toothpaste, Lotions, Antiperspirant, Lip Balm, Perfume, Cologne Oragel, Anbesol Eligible Dual Purpose* Dual Purpose* Ultrasounds Umbilical Cord, Freezing & Storage Eligible Dual Purpose* Urinary Pain Relief Vaginal Infection Treatment Vaporizers Varicose Veins Treatment Vasectomy Vasectomy Reversal Veneers Viagra Vision Discount Programs Vitamins Walkers Wart Removal Medication Weight Loss Programs and/or Drugs Prescribed to Induce Weight Loss Eligible Eligible Dual Purpose* Dual Purpose* Eligible Eligible Not Eligible Eligible Not Eligible Dual Purpose* Eligible Eligible Dual Purpose* Wheelchair Wigs X-ray fees Monistat Compound W Eligible Dual Purpose* Eligible OTC Medicine or Drug Requiring physician's prescription Yes, Rx Required Yes, Rx Required Yes, Rx Required Yes, Rx Required
