Q uestions You Can Ask Yourself to Help Determine Your Expenses
1. What servi ces have you and your family used in the past year?
2. During the next year, do you expect to have similar expenses or other planned health events,
such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic
care or diagnostic procedures?
3. Are you planning any maj or li festyle changes in the next year that may affect your health care
needs (e.g., marriage, birth or adoption)?
4. What is the amount of your annual health, dental or pharmacy plan deductible?
Back
D isc laimer
Your health plan does not guarantee the accuracy or completeness of the calculator. You
will need to evaluate the merits and risks associated with relying on any information
provided. Your health plan is not providing investment or tax or legal recommendations,
advice or endorsem ents.
This calculator is intended to give you an idea of the impact of participating in a Flexible
Spending Account. However, you will need to make the final decision about whether to
contribute. In deciding how much to contribute, keep in mind that unused Flexible Spending
Account contributions will be forfeited.
Actual Federal Withholding amounts, FICA amounts and tax savings will vary based on
your individual tax situation. Please consult a tax professional for more information.
Back
St ep 1: Financial Information I Health Care I Dental Care I Drug I Vision Car e I Dependent Care I Tax Savings
Flexible Spending Account (FSA) Calculator
Use this tool to determine if a Flexible Spending Account is right for you. You can estimate your
contributions and calculate potential tax savings.
Step 1: Financial Information
Please answer these questions to determine your potential tax savings.
Household Gross Income:
0.00
$___________
(Income before taxes)
Filing Status:
Single
Married - Jointly (or qualified Widow)
Married - Separate
Head of Household
Flexible Spending Account Maximums:
0.00
Medical Reimbursement:
$___________
I don't know.
0.00
$___________
I don't know.
Dependent Care:
Be sure to check your benefits booklet or ask your Human Resources department to find out your
maximum contribution amounts.
Clear
Read the calculator tool disclaimer.
Next
Step 2: Financial Informati on I Heal th Car e I Dental Care I Drug I Vision Car e I Dependent Care I Tax Savings
Step 2: Health Care Expenses
To help you decide how much money to put in your Flexible Spending Account, enter your
anticipated out-of-pocket health care costs for this year. To make this easier, you may base these
estimates on your actual expenses from last year. Because you will lose any unused amounts at the
end of the plan year, you may want to be conservative in estimating these expenses.
Last Year
This Year
0.00
$___________
0.00
$___________
Routine office visits
0.00
$___________
0.00
$___________
Specialist visits
0.00
$___________
0.00
$___________
Chiropractor/Acupuncturist visits
0.00
$___________
0.00
$___________
Fertility Treatments
0.00
$___________
0.00
$___________
Surgery
0.00
$___________
0.00
$___________
Therapy sessions
0.00
$___________
0.00
$___________
Other eligible expenses (view)
0.00
$___________
0.00
$___________
Health Care Expense Total
0.00
$___________
0.00
$___________
Expense
Health Deductible
Out-of-Pocket Cost for:
Back
Clear
Next
Step 3: Financial Informati on I Heal th Care I Dental Car e I Dr ug I Vision Care I Dependent Car e I Tax Savings
Step 3: Dental Care Expenses
Enter your anticipated out-of-pocket dental costs for this year. Because you will lose any unused
amounts at the end of the plan year, you may want to be conservative in estimating these expenses.
Last Year
This Year
0.00
$___________
0.00
$___________
Routine office visits
0.00
$___________
0.00
$___________
Additional dental care
0.00
$___________
0.00
$___________
Orthodontic services
0.00
$___________
0.00
$___________
Other eligible expenses (view)
0.00
$___________
0.00
$___________
Dental Care Expense Total
0.00
$___________
0.00
$___________
Medical Expense Total
0.00
$___________
0.00
$___________
Expense
Dental Deductible
(if separate from Health Deductible)
Out-of-Pocket Cost for:
Back
Clear
Next
Step 4: Financial Informati on I Heal th Care I Dental Care I Dr ug I Vi sion Care I Dependent Care I Tax Savi ngs
Step 4: Prescription and Over-the-Counter (OTC) Drug Expenses
Enter your anticipated out-of-pocket prescription and OTC drug costs for this year. Because
you will lose any unused amounts at the end of the plan year, you may want to be conservative in
estimating these expenses.
Expense
Last Year
This Year
0.00
$___________
0.00
$___________
Pharmacy prescriptions
0.00
$___________
0.00
$___________
Mail-order prescriptions
0.00
$___________
0.00
$___________
OTC medications
0.00
$___________
0.00
$___________
Other eligible expenses (view)
0.00
$___________
0.00
$___________
Drug Expense Total
0.00
$___________
0.00
$___________
Medical Expense Total
0.00
$___________
0.00
$___________
Prescription Drug Deductible
(if separate from Health Deductible)
Out-of-Pocket Cost for:
Back
Clear
Next
Step 5: Financial Informati on I Heal th Care I Dental Care I Dr ug I Vi sion Car e I Dependent Care I Tax Savings
Step 5: Vision Care Expenses
Enter your anticipated out-of-pocket vision care costs for this year. Because you will lose
any unused amounts at the end of the plan year, you may want to be conservative in
estimating these expenses.
Last Year
This Year
0.00
$___________
0.00
$___________
Routine eye exams
0.00
$___________
0.00
$___________
Eyeglasses and/or contact lenses
0.00
$___________
0.00
$___________
LASIK surgery
0.00
$___________
0.00
$___________
Other eligible expenses (view)
0.00
$___________
0.00
$___________
Vision Care Expense Total
0.00
$___________
0.00
$___________
Medical Expense Total
0.00
$___________
0.00
$___________
Expense
Vision Deductible
(if separate from Health Deductible)
Out-of-Pocket Cost for:
Back
Clear
Next
Step 6: Financial Informati on I Heal th Care I Dental Care I Dr ug I Vi sion Care I Dependent Care I Tax Savings
Step 6: Dependent Care Expenses
Enter your anticipated out-of-pocket dependent care costs for this year. Because you will lose
any unused amounts at the end of the plan year, you may want to be conservative in estimating
these expenses.
Expense
Last Year
This Year
Child care
0.00
$___________
0.00
$___________
Pre-school tuition
0.00
$___________
0.00
$___________
Adult care
0.00
$___________
0.00
$___________
Other eligible expenses (view)
0.00
$___________
0.00
$___________
Dependent Care Total
0.00
$___________
0.00
$___________
Medical Expense Total
0.00
$___________
0.00
$___________
Out-of-Pocket Cost for:
Back
Clear
Next
Step 7: Financial Informati on I Health Care I Dental Care I Dr ug I Vi sion Care I Dependent Car e I Tax Savi ngs
Step 7: Tax Savings
From the information you entered on the previous screens, it appears you anticipate unreimbursed
expenses in the following amounts for the coming year. You may want to consider funding your
account(s) with the following amounts:
M edical FSA:
0.00
$___________
Dependent Care FSA:
0.00
$___________
Be sure to check your benefits booklet or ask your Human Resources department to find out your
maximum contribution amounts.
With Spending
Account(s)
Without Spending
Account(s)
Gross Annual Income:
0.00
$___________
0.00
$___________
Est. Medical Care Expenses (pre-tax)
0.00
$___________
0.00
$___________
Est. Dependent Care Expenses (pre-tax)
0.00
$___________
0.00
$___________
Taxable Income
0.00
$___________
0.00
$___________
Estimated Federal Wi thholding *
0.00
$___________
0.00
$___________
Estimated FICA *
0.00
$___________
0.00
$___________
E st. Medical Care Expenses (after tax)
0.00
$___________
0.00
$___________
E st . Dependent Care E xpenses (after tax)
0.00
$___________
0.00
$___________
Net Income (spendable income)
0.00
$___________
0.00
$___________
Tax Savings *
0.00
$___________
0.00
$___________
Back Back
Back
Print
Start Over
* R ead the calcu la to r to ol disclaimer.
D isc laimer
Your health plan does not guarantee the accuracy or completeness of the calculator. You
will need to evaluate the merits and risks associated with relying on any information
provided. Your health plan is not providing investment or tax or legal recommendations,
advice or endorsem ents.
This calculator is intended to give you an idea of the impact of participating in a Flexible
Spending Account. However, you will need to make the final decision about whether to
contribute. In deciding how much to contribute, keep in mind that unused Flexible Spending
Account contributions will be forfeited.
Actual Federal Withholding amounts, FICA amounts and tax savings will vary based on
your individual tax situation. Please consult a tax professional for more information.
Back
2007 IRS Qualifying Medical Expenses
Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code.
The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹
Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide
these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a
quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional.
Eligible Medical Expenses (For FSA Distributions)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Abdominal supports
Abortion
Acupuncture
Air conditioner (when necessary
for relief from difficulty in
breathing)
Alcoholism treatment
Ambulance
Anesthetist
Arch supports
Artificial limbs
Autoette (when used for relief of
sickness/disability)
Birth control pills (by
prescription)
Blood tests
Blood transfusions
Braces
Cardiographs
Chiropractor
Christian Science practitioner
Contact lenses
Contraceptive devices (by
prescription)
Convalescent home (for medical
treatment only)
Crutches
Dental treatment
Dental x-rays
Dentures
Dermatologist
Diagnostic fees
Drug addiction therapy
Drugs (prescription)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute
prescribed by a doctor
FICA and FUTA tax paid for medical
care service
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lead paint removal
Legal fees
Lodging (away from home for
outpatient care)
Metabolism tests
Neurologist
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor's
expenses)
Orthopedic shoes
Orthopedist
Osteopath
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Oxygen and oxygen equipment
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical
services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the
handicapped
Spinal fluid test
Splints
Sterilization
Surgeon
Telephone or TV equipment to
assist the hard-of-hearing
Therapy equipment
Transportation expenses
(relative to health care)
Ultra-violet ray treatment
Vaccines
Vasectomy
Vitamins (if prescribed)
Wheelchair
X-rays
Eligible Over-the -Counter Drugs (For FSA Distributions)
§
§
§
§
§
§
Antacids
Allergy medications
Pain relievers
Cold medicine
Anti-diarrhea medicine
Cough drops and throat lozenges
§
§
§
§
§
§
Sinus medications and nasal sprays
Nicotine medications and nasal
sprays
Pedialyte
First aid creams
Calamine lotion
Stop-smoking programs
§
§
§
§
§
Wart removal medication
Antibiotic ointments
Suppositories and creams for
hemorrhoids
Sleep aids
Motion sickness pills
Ineligible Medical Expenses
§
§
§
§
§
§
§
§
Advance payment for
services to be rendered next year
Athletic club membership
Automobile insurance premium
allocable to medical coverage
Boarding school fees
Bottled water
Commuting expenses of a
disabled person
Cosmetic surgery and
procedures
Cosmetics, hygiene products and
similar items
§
§
§
§
§
§
§
§
Funeral, cremation, or burial
expenses
Health programs offered by resort
hotels, health clubs, and gyms
Illegal operations and treatments
Illegally procured drugs
Maternity clothes
Premiums for life insurance, income
protection, disability, loss of limbs,
sight or similar benefits
Scientology counseling
Social activities
§
§
§
§
§
§
Special foods and beverages
Specially designed car for the
handicapped other than an
autoette or special equipment
Swimming pool
Travel for general health
improvement
Tuition and travel expenses
to send a child to a particular
school
Weight loss programs
Ineligible Over-the-Counter Drugs
§
§
§
§
Toiletries (including toothpaste)
Acne treatments
Lip balm (including ChapStick or
Carmex)
Cosmetics (including face cream
and moisturizer)
§
§
§
§
Suntan lotion
Medicated shampoos and soaps
Vitamins (daily)
Fiber supplements
Back
§
§
§
Dietary supplements
Weight loss drugs for general
well being
Herbs
2007 IRS Qualifying Medical Expenses
Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code.
The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹
Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide
these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a
quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional.
Eligible Medical Expenses (For FSA Distributions)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Abdominal supports
Abortion
Acupuncture
Air conditioner (when necessary
for relief from difficulty in
breathing)
Alcoholism treatment
Ambulance
Anesthetist
Arch supports
Artificial limbs
Autoette (when used for relief of
sickness/disability)
Birth control pills (by
prescription)
Blood tests
Blood transfusions
Braces
Cardiographs
Chiropractor
Christian Science practitioner
Contact lenses
Contraceptive devices (by
prescription)
Convalescent home (for medical
treatment only)
Crutches
Dental treatment
Dental x-rays
Dentures
Dermatologist
Diagnostic fees
Drug addiction therapy
Drugs (prescription)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute
prescribed by a doctor
FICA and FUTA tax paid for medical
care service
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lead paint removal
Legal fees
Lodging (away from home for
outpatient care)
Metabolism tests
Neurologist
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor's
expenses)
Orthopedic shoes
Orthopedist
Osteopath
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Oxygen and oxygen equipment
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical
services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the
handicapped
Spinal fluid test
Splints
Sterilization
Surgeon
Telephone or TV equipment to
assist the hard-of-hearing
Therapy equipment
Transportation expenses
(relative to health care)
Ultra-violet ray treatment
Vaccines
Vasectomy
Vitamins (if prescribed)
Wheelchair
X-rays
Eligible Over-the -Counter Drugs (For FSA Distributions)
§
§
§
§
§
§
Antacids
Allergy medications
Pain relievers
Cold medicine
Anti-diarrhea medicine
Cough drops and throat lozenges
§
§
§
§
§
§
Sinus medications and nasal sprays
Nicotine medications and nasal
sprays
Pedialyte
First aid creams
Calamine lotion
Stop-smoking programs
§
§
§
§
§
Wart removal medication
Antibiotic ointments
Suppositories and creams for
hemorrhoids
Sleep aids
Motion sickness pills
Ineligible Medical Expenses
§
§
§
§
§
§
§
§
Advance payment for
services to be rendered next year
Athletic club membership
Automobile insurance premium
allocable to medical coverage
Boarding school fees
Bottled water
Commuting expenses of a
disabled person
Cosmetic surgery and
procedures
Cosmetics, hygiene products and
similar items
§
§
§
§
§
§
§
§
Funeral, cremation, or burial
expenses
Health programs offered by resort
hotels, health clubs, and gyms
Illegal operations and treatments
Illegally procured drugs
Maternity clothes
Premiums for life insurance, income
protection, disability, loss of limbs,
sight or similar benefits
Scientology counseling
Social activities
§
§
§
§
§
§
Special foods and beverages
Specially designed car for the
handicapped other than an
autoette or special equipment
Swimming pool
Travel for general health
improvement
Tuition and travel expenses
to send a child to a particular
school
Weight loss programs
Ineligible Over-the-Counter Drugs
§
§
§
§
Toiletries (including toothpaste)
Acne treatments
Lip balm (including ChapStick or
Carmex)
Cosmetics (including face cream
and moisturizer)
§
§
§
§
Suntan lotion
Medicated shampoos and soaps
Vitamins (daily)
Fiber supplements
Back
§
§
§
Dietary supplements
Weight loss drugs for general
well being
Herbs
2007 IRS Qualifying Medical Expenses
Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code.
The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹
Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide
these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a
quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional.
Eligible Medical Expenses (For FSA Distributions)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Abdominal supports
Abortion
Acupuncture
Air conditioner (when necessary
for relief from difficulty in
breathing)
Alcoholism treatment
Ambulance
Anesthetist
Arch supports
Artificial limbs
Autoette (when used for relief of
sickness/disability)
Birth control pills (by
prescription)
Blood tests
Blood transfusions
Braces
Cardiographs
Chiropractor
Christian Science practitioner
Contact lenses
Contraceptive devices (by
prescription)
Convalescent home (for medical
treatment only)
Crutches
Dental treatment
Dental x-rays
Dentures
Dermatologist
Diagnostic fees
Drug addiction therapy
Drugs (prescription)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute
prescribed by a doctor
FICA and FUTA tax paid for medical
care service
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lead paint removal
Legal fees
Lodging (away from home for
outpatient care)
Metabolism tests
Neurologist
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor's
expenses)
Orthopedic shoes
Orthopedist
Osteopath
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Oxygen and oxygen equipment
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical
services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the
handicapped
Spinal fluid test
Splints
Sterilization
Surgeon
Telephone or TV equipment to
assist the hard-of-hearing
Therapy equipment
Transportation expenses
(relative to health care)
Ultra-violet ray treatment
Vaccines
Vasectomy
Vitamins (if prescribed)
Wheelchair
X-rays
Eligible Over-the -Counter Drugs (For FSA Distributions)
§
§
§
§
§
§
Antacids
Allergy medications
Pain relievers
Cold medicine
Anti-diarrhea medicine
Cough drops and throat lozenges
§
§
§
§
§
§
Sinus medications and nasal sprays
Nicotine medications and nasal
sprays
Pedialyte
First aid creams
Calamine lotion
Stop-smoking programs
§
§
§
§
§
Wart removal medication
Antibiotic ointments
Suppositories and creams for
hemorrhoids
Sleep aids
Motion sickness pills
Ineligible Medical Expenses
§
§
§
§
§
§
§
§
Advance payment for
services to be rendered next year
Athletic club membership
Automobile insurance premium
allocable to medical coverage
Boarding school fees
Bottled water
Commuting expenses of a
disabled person
Cosmetic surgery and
procedures
Cosmetics, hygiene products and
similar items
§
§
§
§
§
§
§
§
Funeral, cremation, or burial
expenses
Health programs offered by resort
hotels, health clubs, and gyms
Illegal operations and treatments
Illegally procured drugs
Maternity clothes
Premiums for life insurance, income
protection, disability, loss of limbs,
sight or similar benefits
Scientology counseling
Social activities
§
§
§
§
§
§
Special foods and beverages
Specially designed car for the
handicapped other than an
autoette or special equipment
Swimming pool
Travel for general health
improvement
Tuition and travel expenses
to send a child to a particular
school
Weight loss programs
Ineligible Over-the-Counter Drugs
§
§
§
§
Toiletries (including toothpaste)
Acne treatments
Lip balm (including ChapStick or
Carmex)
Cosmetics (including face cream
and moisturizer)
§
§
§
§
Suntan lotion
Medicated shampoos and soaps
Vitamins (daily)
Fiber supplements
Back
§
§
§
Dietary supplements
Weight loss drugs for general
well being
Herbs
2007 IRS Qualifying Medical Expenses
Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code.
The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹
Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide
these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a
quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional.
Eligible Medical Expenses (For FSA Distributions)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Abdominal supports
Abortion
Acupuncture
Air conditioner (when necessary
for relief from difficulty in
breathing)
Alcoholism treatment
Ambulance
Anesthetist
Arch supports
Artificial limbs
Autoette (when used for relief of
sickness/disability)
Birth control pills (by
prescription)
Blood tests
Blood transfusions
Braces
Cardiographs
Chiropractor
Christian Science practitioner
Contact lenses
Contraceptive devices (by
prescription)
Convalescent home (for medical
treatment only)
Crutches
Dental treatment
Dental x-rays
Dentures
Dermatologist
Diagnostic fees
Drug addiction therapy
Drugs (prescription)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute
prescribed by a doctor
FICA and FUTA tax paid for medical
care service
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lead paint removal
Legal fees
Lodging (away from home for
outpatient care)
Metabolism tests
Neurologist
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor's
expenses)
Orthopedic shoes
Orthopedist
Osteopath
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Oxygen and oxygen equipment
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical
services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the
handicapped
Spinal fluid test
Splints
Sterilization
Surgeon
Telephone or TV equipment to
assist the hard-of-hearing
Therapy equipment
Transportation expenses
(relative to health care)
Ultra-violet ray treatment
Vaccines
Vasectomy
Vitamins (if prescribed)
Wheelchair
X-rays
Eligible Over-the -Counter Drugs (For FSA Distributions)
§
§
§
§
§
§
Antacids
Allergy medications
Pain relievers
Cold medicine
Anti-diarrhea medicine
Cough drops and throat lozenges
§
§
§
§
§
§
Sinus medications and nasal sprays
Nicotine medications and nasal
sprays
Pedialyte
First aid creams
Calamine lotion
Stop-smoking programs
§
§
§
§
§
Wart removal medication
Antibiotic ointments
Suppositories and creams for
hemorrhoids
Sleep aids
Motion sickness pills
Ineligible Medical Expenses
§
§
§
§
§
§
§
§
Advance payment for
services to be rendered next year
Athletic club membership
Automobile insurance premium
allocable to medical coverage
Boarding school fees
Bottled water
Commuting expenses of a
disabled person
Cosmetic surgery and
procedures
Cosmetics, hygiene products and
similar items
§
§
§
§
§
§
§
§
Funeral, cremation, or burial
expenses
Health programs offered by resort
hotels, health clubs, and gyms
Illegal operations and treatments
Illegally procured drugs
Maternity clothes
Premiums for life insurance, income
protection, disability, loss of limbs,
sight or similar benefits
Scientology counseling
Social activities
§
§
§
§
§
§
Special foods and beverages
Specially designed car for the
handicapped other than an
autoette or special equipment
Swimming pool
Travel for general health
improvement
Tuition and travel expenses
to send a child to a particular
school
Weight loss programs
Ineligible Over-the-Counter Drugs
§
§
§
§
Toiletries (including toothpaste)
Acne treatments
Lip balm (including ChapStick or
Carmex)
Cosmetics (including face cream
and moisturizer)
§
§
§
§
Suntan lotion
Medicated shampoos and soaps
Vitamins (daily)
Fiber supplements
Back
§
§
§
Dietary supplements
Weight loss drugs for general
well being
Herbs
2007 IRS Qualifying Medical Expenses
Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code.
The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹
Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide
these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a
quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional.
Eligible Medical Expenses (For FSA Distributions)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Abdominal supports
Abortion
Acupuncture
Air conditioner (when necessary
for relief from difficulty in
breathing)
Alcoholism treatment
Ambulance
Anesthetist
Arch supports
Artificial limbs
Autoette (when used for relief of
sickness/disability)
Birth control pills (by
prescription)
Blood tests
Blood transfusions
Braces
Cardiographs
Chiropractor
Christian Science practitioner
Contact lenses
Contraceptive devices (by
prescription)
Convalescent home (for medical
treatment only)
Crutches
Dental treatment
Dental x-rays
Dentures
Dermatologist
Diagnostic fees
Drug addiction therapy
Drugs (prescription)
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute
prescribed by a doctor
FICA and FUTA tax paid for medical
care service
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lead paint removal
Legal fees
Lodging (away from home for
outpatient care)
Metabolism tests
Neurologist
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor's
expenses)
Orthopedic shoes
Orthopedist
Osteopath
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
§
Oxygen and oxygen equipment
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical
services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the
handicapped
Spinal fluid test
Splints
Sterilization
Surgeon
Telephone or TV equipment to
assist the hard-of-hearing
Therapy equipment
Transportation expenses
(relative to health care)
Ultra-violet ray treatment
Vaccines
Vasectomy
Vitamins (if prescribed)
Wheelchair
X-rays
Eligible Over-the -Counter Drugs (For FSA Distributions)
§
§
§
§
§
§
Antacids
Allergy medications
Pain relievers
Cold medicine
Anti-diarrhea medicine
Cough drops and throat lozenges
§
§
§
§
§
§
Sinus medications and nasal sprays
Nicotine medications and nasal
sprays
Pedialyte
First aid creams
Calamine lotion
Stop-smoking programs
§
§
§
§
§
Wart removal medication
Antibiotic ointments
Suppositories and creams for
hemorrhoids
Sleep aids
Motion sickness pills
Ineligible Medical Expenses
§
§
§
§
§
§
§
§
Advance payment for
services to be rendered next year
Athletic club membership
Automobile insurance premium
allocable to medical coverage
Boarding school fees
Bottled water
Commuting expenses of a
disabled person
Cosmetic surgery and
procedures
Cosmetics, hygiene products and
similar items
§
§
§
§
§
§
§
§
Funeral, cremation, or burial
expenses
Health programs offered by resort
hotels, health clubs, and gyms
Illegal operations and treatments
Illegally procured drugs
Maternity clothes
Premiums for life insurance, income
protection, disability, loss of limbs,
sight or similar benefits
Scientology counseling
Social activities
§
§
§
§
§
§
Special foods and beverages
Specially designed car for the
handicapped other than an
autoette or special equipment
Swimming pool
Travel for general health
improvement
Tuition and travel expenses
to send a child to a particular
school
Weight loss programs
Ineligible Over-the-Counter Drugs
§
§
§
§
Toiletries (including toothpaste)
Acne treatments
Lip balm (including ChapStick or
Carmex)
Cosmetics (including face cream
and moisturizer)
§
§
§
§
Suntan lotion
Medicated shampoos and soaps
Vitamins (daily)
Fiber supplements
Back
§
§
§
Dietary supplements
Weight loss drugs for general
well being
Herbs
Q uestions You Can Ask Yourself to Help Determine Your Expenses
1. What servi ces have you and your family used in the past year?
2. During the next year, do you expect to have similar expenses or other planned health events,
such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic
care or diagnostic procedures?
3. Are you planning any maj or li festyle changes in the next year that may affect your health care
needs (e.g., marriage, birth or adoption)?
4. What is the amount of your annual health, dental or pharmacy plan deductible?
Back
Q uestions You Can Ask Yourself to Help Determine Your Expenses
1. What servi ces have you and your family used in the past year?
2. During the next year, do you expect to have similar expenses or other planned health events,
such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic
care or diagnostic procedures?
3. Are you planning any maj or li festyle changes in the next year that may affect your health care
needs (e.g., marriage, birth or adoption)?
4. What is the amount of your annual health, dental or pharmacy plan deductible?
Back
Q uestions You Can Ask Yourself to Help Determine Your Expenses
1. What servi ces have you and your family used in the past year?
2. During the next year, do you expect to have similar expenses or other planned health events,
such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic
care or diagnostic procedures?
3. Are you planning any maj or li festyle changes in the next year that may affect your health care
needs (e.g., marriage, birth or adoption)?
4. What is the amount of your annual health, dental or pharmacy plan deductible?
Back
Q uestions You Can Ask Yourself to Help Determine Your Expenses
1. What servi ces have you and your family used in the past year?
2. During the next year, do you expect to have similar expenses or other planned health events,
such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic
care or diagnostic procedures?
3. Are you planning any maj or li festyle changes in the next year that may affect your health care
needs (e.g., marriage, birth or adoption)?
4. What is the amount of your annual health, dental or pharmacy plan deductible?
Back