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Health Care FSA

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) 
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 (other; 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 (dental or vision) Yes 
Diagnostic services (other than 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) 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 
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) 
Flu shots Yes 
Funeral expenses No 
Gastrointestinal medication (over-the-counter) Yes (Rx) 
Guide dog (dog, 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 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 (fixed indemnity) insurance premiums No 
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 
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) 
Monitors & test kits (over-the-counter) Yes 
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 (eligible) 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 
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 (toothbrush, toothpaste, etc.) 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