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Selected Program
| Name |
Plan |
|
Chiropractic care |
Yes |
|
Co-payment (medical, in-network) |
Yes |
|
Contact lenses and solutions |
Yes |
|
Dental |
Yes |
|
Hospital fees |
Yes |
|
Lab (medical) |
Yes |
|
Menstrual care products (Liners, Pads, Tampons, Cups, Menstrual undergarments) |
No |
|
Mileage (for travel to/from eligible health care) |
Yes |
|
Office visit (medical) |
Yes |
|
Orthodontia |
Yes |
|
Over-the-counter (drugs and medicines) |
Yes (Rx) |
|
Over-the-counter health care products (eligible) |
Yes (Rx) |
|
Psych / therapy |
Yes |
|
Rx (prescription) |
Yes |
|
Telehealth / remote care |
Yes |
|
Vision |
Yes |
|
X-ray (medical) |
Yes |
|
Acne treatments (over-the-counter) |
Yes (Rx) |
|
Acupuncture |
Yes |
|
Adoption (medical expenses related to) |
Yes |
|
Adoption fees |
No |
|
Alcoholism treatment |
Yes |
|
Allergy & sinus medicine and products (over-the-counter) |
Yes (Rx) |
|
Allergy medication |
Yes (Rx) |
|
Allergy treatments and products |
Yes (Letter) |
|
Alternative dietary supplements (for treatment of a medical condition) |
Yes (Letter) |
|
Alternative drugs, medicines and treatment products (for treatment of a medical condition) |
Yes (Letter) |
|
Alternative healers (for treatment of a medical condition) |
Yes (Letter) |
|
Ambulance and emergency health services |
Yes |
|
Anesthesia (for non-cosmetic purposes) |
Yes |
|
Antacid (over-the-counter) |
Yes (Rx) |
|
Antibiotic ointment (over-the-counter) |
Yes (Rx) |
|
Aspirin or other pain reliever (over-the-counter) |
Yes (Rx) |
|
Asthma medicines or treatments (over-the-counter) |
Yes (Rx) |
|
Athletic treatments / braces |
Yes |
|
Bandages and related items (over-the-counter) |
Yes |
|
Birth control (over-the-counter) |
Yes (Rx) |
|
Birth control (prescription) |
Yes |
|
Blood pressure monitor |
Yes |
|
Body scans |
Yes |
|
Braille books and magazines (difference in cost only) |
Yes |
|
Breast pump (for a lactating woman) |
Yes |
|
Breast reconstruction surgery (following mastectomy) |
Yes (Letter) |
|
Breastfeeding classes |
Yes |
|
COBRA premiums (dental; paid with after-tax dollars only) |
No |
|
COBRA premiums (medical; paid with after-tax dollars only) |
No |
|
COBRA premiums (paid with after-tax dollars only) |
No |
|
COBRA premiums (prescription; paid with after-tax dollars only) |
No |
|
COBRA premiums (vision; paid with after-tax dollars only) |
No |
|
CPR classes (adult or child) |
No |
|
Canker & cold sore treatments (over-the-counter) |
Yes (Rx) |
|
Car modifications (as required for a medical condition diagnosed by a licensed health care professional) |
Yes (Letter) |
|
Chest rubs (over-the-counter) |
Yes (Rx) |
|
Child or newborn care instruction |
No |
|
Childbirth classes (charges for mother only) |
Yes |
|
Chiropractic office visit or treatment |
Yes |
|
Cholesterol test kits and supplies |
Yes |
|
Christian Science practitioners |
Yes |
|
Co-insurance (dental, in-network) |
Yes |
|
Co-insurance (dental, out-of-network) |
Yes |
|
Co-insurance (medical, in-network) |
Yes |
|
Co-insurance (medical, out-of-network) |
Yes |
|
Co-insurance (prescription, in-network) |
Yes |
|
Co-insurance (prescription, out-of-network) |
Yes |
|
Co-insurance (vision, in-network) |
Yes |
|
Co-insurance (vision, out-of-network) |
Yes |
|
Co-payment (dental, in-network) |
Yes |
|
Co-payment (dental, out-of-network) |
Yes |
|
Co-payment (vision, in-network) |
Yes |
|
Co-payment (vision, out-of-network) |
Yes |
|
Cold & flu medicine (over-the-counter) |
Yes (Rx) |
|
Cold cream (over-the-counter) |
No |
|
Compression or anti-embolism socks, stockings or hose |
Yes (Letter) |
|
Concierge medical fees (billed for actual services received) |
Yes |
|
Concierge medical fees (billed for future availability of services, with no services actually received) |
No |
|
Condoms |
Yes |
|
Contraceptives (over-the-counter) |
Yes (Rx) |
|
Contraceptives (prescription) |
Yes |
|
Cord blood storage (for future treatment of a birth defect or known medical condition) |
Yes (Letter) |
|
Cord blood storage (for unidentified future use) |
No |
|
Corn and callus remover (over-the-counter) |
Yes (Rx) |
|
Corneal keratotomy |
Yes |
|
Cosmetic procedures or surgery |
No |
|
Cosmetic procedures or surgery for birth defects, accidents, and/or disease |
Yes (Letter) |
|
Cough drops & sore throat lozenges (over-the-counter) |
Yes (Rx) |
|
Cough syrup (over-the-counter) |
Yes (Rx) |
|
Counseling (for treatment of a medical condition) |
Yes |
|
Counseling (marriage) |
No |
|
Crutches, canes, walkers or like equipment (purchase or rental) |
Yes |
|
Dancing lessons (for treatment of a medical condition) |
Yes (Letter) |
|
Deductible (dental, in-network) |
Yes |
|
Deductible (dental, out-of-network) |
Yes |
|
Deductible (medical, in-network) |
Yes |
|
Deductible (medical, out-of-network) |
Yes |
|
Deductible (prescription, in-network) |
Yes |
|
Deductible (prescription, out-of-network) |
Yes |
|
Deductible (vision, in-network) |
Yes |
|
Deductible (vision, out-of-network) |
Yes |
|
Dental Co-insurance (in-network) |
Yes |
|
Dental Co-insurance (out-of-network) |
Yes |
|
Dental Co-payment (in-network) |
Yes |
|
Dental Co-payment (out-of-network) |
Yes |
|
Dental insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Dental products for general health |
No |
|
Dental veneers |
Yes (Letter) |
|
Dentures, bridges, etc. |
Yes |
|
Dermatology treatments and products |
Yes (Letter) |
|
Diabetic monitors, test kits, strips and supplies |
Yes |
|
Diagnostic Services (medical) |
Yes |
|
Diagnostic services (dental or vision) |
Yes |
|
Diaper rash ointments and creams |
Yes (Rx) |
|
Diapers and diaper services |
No |
|
Dietary supplements (for treatment of a medical condition) |
Yes (Letter) |
|
Doula or birthing coach |
Yes (Letter) |
|
Drug addiction treatment |
Yes |
|
Drugs (imported) / Medical Marijuana / CBD |
No |
|
Drugs (prescription) |
Yes |
|
Dyslexia treatment |
Yes (Letter) |
|
Ear drops & wax removal (over-the-counter) |
Yes (Rx) |
|
Educational classes or tuition |
No |
|
Electrolysis |
No |
|
Emergency kits (over-the-counter) |
No |
|
Exercise equipment or program (as treatment for a medical condition diagnosed by a licensed health care professional) |
Yes (Letter) |
|
Eye drops and treatments (over-the-counter) |
Yes (Rx) |
|
Eye examinations |
Yes |
|
Eye related equipment/materials |
Yes |
|
Eye surgery or treatment to correct vision |
Yes |
|
Eyeglasses (over-the-counter) |
Yes |
|
Eyeglasses (prescription) |
Yes |
|
Face lifts |
No |
|
Feminine hygiene care (Deodorants, General Cleansing products, Feminine spray) |
No |
|
Fertility monitor (over-the-counter) |
Yes |
|
Fertility treatment (for employee, spouse or dependent) |
Yes (Letter) |
|
Fertility treatment (for non-dependent surrogate) |
No |
|
First aid kits (over-the-counter) |
Yes |
|
Fitness programs (as treatment for a medical condition diagnosed by a licensed health care professional) |
Yes (Letter) |
|
Fixed Indemnity insurance premiums (Hospital, Cancer Accident, Health) |
No |
|
Flu shots |
Yes |
|
Funeral expenses |
No |
|
Gastrointestinal medication (over-the-counter) |
Yes (Rx) |
|
Guide Dog, Service Animal (animal, training care) |
Yes (Letter) |
|
Hair regrowth products |
No |
|
Hair removal |
No |
|
Hair transplant |
No |
|
Hair treatments |
No |
|
Hand lotion (over-the-counter) |
No |
|
Health club dues (as treatment for a medical condition diagnosed by a licensed health care professional) |
Yes (Letter) |
|
Health insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Health plan claim from dental plan provider (total not covered by that plan) |
Yes |
|
Health plan claim from medical plan provider (total not covered by that plan) |
Yes |
|
Health plan claim from pharmacy plan provider (total not covered by that plan) |
Yes |
|
Health plan claim from vision plan provider (total not covered by that plan) |
Yes |
|
Health savings account (HSA) contributions |
No |
|
Hearing Aid (Over-the-counter) |
Yes |
|
Hearing Aid Batteries |
Yes |
|
Hearing Aids |
Yes |
|
Herbal or homeopathic medicines (over-the-counter) |
Yes (Letter) |
|
Home improvements (as required for a medical condition diagnosed by a licensed health care professional) |
Yes (Letter) |
|
Hospital services and fees |
Yes |
|
Household help |
No |
|
Humidifier, air filter and supplies |
Yes (Letter) |
|
Illegal operations or substances |
No |
|
Immunizations |
Yes |
|
Incontinence supplies |
Yes |
|
Individual dental insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Individual insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Individual medical insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Individual prescription insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Individual vision insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Infertility treatment (for employee, spouse or dependent) |
Yes |
|
Insulin, testing materials and supplies |
Yes |
|
Insurance / plan premiums (paid with pre-tax dollars) |
No |
|
Insurance or health insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Laboratory fees |
Yes |
|
Lactose intolerance (over-the-counter) |
Yes (Rx) |
|
Lamaze classes (charges for mother only) |
Yes |
|
Laser eye surgery |
Yes |
|
Lasik |
Yes |
|
Late payment fees charged by health care provider |
No |
|
Laxatives (over-the-counter) |
Yes (Rx) |
|
Learning disability treatments |
Yes (Letter) |
|
Lice treatment (over-the-counter) |
Yes (Rx) |
|
Listening therapy |
Yes |
|
Lodging (limited to $50 per night for patient to receive medical care and $50 per night for one caregiver) |
Yes (Letter) |
|
Long term care premiums (up to IRS tax-free limit, see IRS Publication 502) |
No |
|
Long term care services |
No |
|
Long term disability insurance premiums |
No |
|
Magnetic therapy (over-the-counter) |
Yes (Letter) |
|
Massage therapy (for treatment of a medical condition) |
Yes (Letter) |
|
Mastectomy-related special bras |
Yes |
|
Maternity clothes |
No |
|
Medical Co-insurance (in-network) |
Yes |
|
Medical Co-insurance (out-of-network) |
Yes |
|
Medical Co-payment (in-network) |
Yes |
|
Medical Co-payment (out-of-network) |
Yes |
|
Medical abortion |
Yes |
|
Medical equipment (for treatment of medical condition) and repairs |
Yes |
|
Medical insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Medical literature, books, pamphlets or audio |
No |
|
Medical monitoring and testing devices |
Yes |
|
Medical records charges |
Yes |
|
Medical savings account (MSA) contributions |
No |
|
Medical supplies (for treatment of a medical condition) |
Yes |
|
Medicare Part B insurance / plan premiums |
No |
|
Medicare alternative insurance / plan premiums (vs. Part A & Part B, paid with after-tax dollars only) |
No |
|
Medicare supplement policy premiums |
No |
|
Medicines (over-the-counter) |
Yes (Rx) |
|
Medicines (prescription) |
Yes |
|
Midwife |
Yes |
|
Mileage (for travel to / from anything other than eligible care) |
No |
|
Modified equipment (difference in cost only) |
Yes (Letter) |
|
Motion & nausea |
Yes (Rx) |
|
Nasal sprays |
Yes (Rx) |
|
Nasal strips (over-the-counter) |
Yes (Rx) |
|
No show fees charged by health care provider |
No |
|
Non-prescription drugs and medicines (for non-cosmetic purposes) |
Yes (Rx) |
|
Norplant insertion or removal |
Yes |
|
Nursing services (wages and taxes) |
Yes |
|
Nutritional supplements (for treatment of a medical condition) |
Yes (Letter) |
|
OB/GYN fees |
Yes |
|
Occlusal guards to prevent teeth grinding |
Yes |
|
Occupational therapy (related to a medical condition or disability) |
Yes |
|
Office visits (chiro) |
Yes |
|
Office visits (dental) |
Yes |
|
Office visits (medical) |
Yes |
|
Office visits (psych/therapy) |
Yes |
|
Office visits (vision) |
Yes |
|
Operations (for non-cosmetic purposes) |
Yes |
|
Operations (for vision and dental only) |
Yes |
|
Opthamologist fees for medical eye condition |
Yes |
|
Opthamologist fees for routine eye care |
Yes |
|
Optometrist fees |
Yes |
|
Oral care (over-the-counter) |
No |
|
Organ transplants (recipient and donor) |
Yes |
|
Ortho keratotomy |
Yes |
|
Orthodontia (braces and retainers) |
Yes |
|
Orthopedic & surgical supports |
Yes |
|
Orthopedic shoes and inserts (difference in cost only of specialized orthopedic shoe over like non-specialized shoe) |
Yes (Letter) |
|
Orthotics |
Yes |
|
Over-the-counter acne treatments |
Yes (Rx) |
|
Over-the-counter allergy & sinus medicine |
Yes (Rx) |
|
Over-the-counter antacid |
Yes (Rx) |
|
Over-the-counter antibiotic ointment |
Yes (Rx) |
|
Over-the-counter aspirin or other pain reliever |
Yes (Rx) |
|
Over-the-counter asthma medicines or treatments |
Yes (Rx) |
|
Over-the-counter bandages and related items |
Yes |
|
Over-the-counter canker & cold sore treatments |
Yes (Rx) |
|
Over-the-counter chest rubs |
Yes (Rx) |
|
Over-the-counter cold & flu medicine |
Yes (Rx) |
|
Over-the-counter cold & flu prevention |
Yes (Rx) |
|
Over-the-counter cold cream |
No |
|
Over-the-counter cough drops & sore throat lozenges |
Yes (Rx) |
|
Over-the-counter cough syrup |
Yes (Rx) |
|
Over-the-counter health care products (not eligible) |
No |
|
Over-the-counter medication (including for motion sickness, sleep aids and sedatives) |
Yes (Rx) |
|
Over-the-counter products for dental, oral and teething pain |
Yes (Rx) |
|
Over-the-counter products for general dental care |
No |
|
Ovulation monitor (over-the-counter) |
Yes |
|
Oxygen |
Yes |
|
Pain reliever (over-the-counter) |
Yes (Rx) |
|
Parental fees (billed for actual services received for disabled children) |
Yes |
|
Parental fees (billed for future availability of services, with no services actually received for disabled children) |
No |
|
Personal use items |
No |
|
Physical exams |
Yes |
|
Physical therapy |
Yes |
|
Physician retainer fee (for on-call or concierge services) |
No |
|
Pregnancy tests (over-the-counter) |
Yes |
|
Prescription Co-insurance (in-network) |
Yes |
|
Prescription Co-insurance (out-of-network) |
Yes |
|
Prescription Co-payment (in-network) |
Yes |
|
Prescription Co-payment (out-of-network) |
Yes |
|
Prescription drugs (for non-cosmetic purposes) |
Yes |
|
Prescription drugs for cosmetic purposes |
No |
|
Prescription drugs for hair regrowth |
No |
|
Prescription insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Propecia (for treatment of a medical condition) |
Yes (Letter) |
|
Prosthesis |
Yes |
|
Psychiatric care |
Yes |
|
Psychoanalysis |
Yes |
|
Psychologist fees |
Yes |
|
Radial keratotomy (RK) |
Yes |
|
Reading glasses (over-the-counter) |
Yes |
|
Reconstructive surgery (following accident or medical procedure or condition) |
Yes (Letter) |
|
Removal of benign mole, cyst or tumor |
Yes |
|
Retainer fee (to physician for on-call or concierge services) |
No |
|
Retin-A (for non-cosmetic purposes) |
Yes (Rx) |
|
Rogaine or other hair regrowth medications (even if prescribed) |
No |
|
Sales tax, shipping and handling fees (for any eligible expense) |
Yes |
|
Smoking cessation (programs / counseling) |
Yes |
|
Smoking cessation drugs (prescription) |
Yes |
|
Smoking cessation gum or patches (over-the-counter) |
Yes |
|
Special equipment |
Yes (Letter) |
|
Special foods (gluten-free, salt-free or other for treatment of a medical condition; difference in cost only) |
Yes (Letter) |
|
Special school (for mental and physical disabilities) |
Yes (Letter) |
|
Speech therapy |
Yes |
|
Spermicidals |
Yes (Rx) |
|
Sterilization |
Yes |
|
Student health fees for dental services (billed for actual services received) |
Yes |
|
Student health fees for dental services (no services actually received, billed for future availability of services) |
No |
|
Student health fees for medical services (billed for actual services received) |
Yes |
|
Student health fees for medical services (no services actually received, billed for future availability of services) |
No |
|
Student health fees for prescription services (no services actually received, billed for future availability of services) |
No |
|
Student health fees for prescriptions (billed for actual services received) |
Yes |
|
Student health fees for vision services (billed for actual services received) |
Yes |
|
Student health fees for vision services (no services actually received, billed for future availability of services) |
No |
|
Sunglasses (over-the-counter) |
No |
|
Sunglasses (prescription) |
Yes |
|
Sunscreen with SPF 15+ and "broad spectrum", sunburn creams and ointments (over-the-counter) |
Yes |
|
Sunscreen with SPF <15 or suntan lotion (over-the-counter) |
No |
|
Supplies (for treatment of a medical condition) |
Yes |
|
Surgery (for non-cosmetic purposes) |
Yes |
|
Swimming lessons (for treatment of a medical condition) |
Yes (Letter) |
|
Teeth bleaching or whitening |
No |
|
Teeth grinding prevention devices |
Yes |
|
Therapy (for treatment of a medical condition) |
Yes |
|
Toothache and teething pain reliever (over-the-counter) |
Yes (Rx) |
|
Toothpaste, medicated (difference in cost only of medicated toothpaste over the standard toothpaste) |
Yes (Rx) |
|
Toothpaste, toothbrush, floss, etc. |
No |
|
Transgender treatments / surgery |
Yes (Letter) |
|
Transportation, parking and related travel expenses (essential to receive eligible care) |
Yes |
|
Transportation, parking and related travel expenses, for non-eligible expenses |
No |
|
Tubal ligation |
Yes |
|
Tuition or educational classes |
No |
|
Tuition or educational classes (for a specific medical condition) |
Yes (Letter) |
|
UV protection clothing |
No |
|
Urological products |
Yes |
|
Vaccinations |
Yes |
|
Varicose vein removal surgery (for medical care) |
Yes |
|
Vasectomy |
Yes |
|
Viagra and similar prescription medications |
Yes |
|
Vision Co-insurance (in-network) |
Yes |
|
Vision Co-insurance (out-of-network) |
Yes |
|
Vision Co-payment (in-network) |
Yes |
|
Vision Co-payment (out-of-network) |
Yes |
|
Vision insurance / plan premiums (paid with after-tax dollars only) |
No |
|
Vitamins (over-the-counter, for general health purposes) |
Yes (Letter) |
|
Vitamins (prescription) |
Yes |
|
Walking aids (canes, walkers, crutches and related supplies) |
Yes |
|
Warranties or other charges for future anticipated services (with none actually received) |
No |
|
Wart removal treatments (over-the-counter) |
Yes (Rx) |
|
Weight loss counseling |
Yes (Letter) |
|
Weight loss drugs (for treatment of a medical condition) |
Yes (Letter) |
|
Weight loss foods |
No |
|
Weight loss program (for treatment of a medical condition) |
Yes (Letter) |
|
Weight loss program (to improve or maintain general health) |
No |
|
Wheelchair and repairs |
Yes |
|
Wound care (over-the-counter) |
Yes |
|
X-ray fees (dental) |
Yes |
|
X-ray fees (medical) |
Yes |