Below is a sample list of permissible expenses reimbursable through a full scope Healthcare Flexible Spending Account
(FSA) that is incurred by you, your spouse, or qualified dependents. Please note, a limited purpose Healthcare FSA only allows dental and vision expenses.

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Medical Expenses

• Acupuncture
• Artificial limbs
• Bandages
• Birth control, contraceptive devices
• Birthing classes/Lamaze – only the mother’s portion (not the coach/spouse) and the class must
• be only for birthing instruction, not child rearing
• Blood pressure monitor
• Blood sugar test kits/test strips
• Chiropractic therapy/exams/adjustments
• Contact lens and contact lens solutions
• Co-payments
• Crutches (purchased or rented)
• Deductible and co-insurance
• Diabetic supplies
• Eye exams
• Eyeglasses, contacts, or safety glasses, prescription only (warranties are not reimbursable)
• Flu shots
• Hearing aids and hearing aid batteries (warranties are not reimbursable)
• Heating pad
• Incontinence supplies
• Infertility treatments
• Insulin
• Lactation expenses (breast pumps, etc.)
• Laser eye surgery; LASIK
• Legal sterilization
• Medical supplies to treat an injury or illness
• Mileage to and from doctor appointments
• Nasal strips
• Optometrist’s or ophthalmologist’s fees
• Orthopedic inserts
• Physicals
• Physical therapy (as medical treatment)
• Physician’s fee and hospital services
• Pregnancy test
• Prescription drugs and medications
• Psychotherapy, psychiatric and psychological service
• Reading glasses
• Sales tax on eligible expenses
• Services connected with donating an organ
• Sleep apnea services/products (as prescribed)
• Smoking cessation programs
• Treatment for alcoholism or drug dependency Vaccinations
• Wrist supports, elastic wraps
• X-ray fees

OTC Medicines and Drugs

Other than insulin, in the past, over-the-counter (OTC) medicines and drugs required a prescription from your physician to be reimbursable. Effective January 1, 2020, however, a doctor’s prescription is not necessary.

• Bengay, Flexall, pain relieving creams or gels
• Calamine lotion
• Canker/cold sore relievers
• Cold medicines
• Corn removal
• Diaper rash ointment
• GasX, baby gas drops
• Hemorrhoid creams and treatments
• Hydrogen Peroxide or rubbing alcohol
• Indigestion or anti-acid relievers
• Laxatives
• Nicotine patch
• Pain relievers (Tylenol, Advil, Aspirin, etc.)
• Sinus medicines
• Suppositories
• Teething gel
• Wart removal medication

Menstrual Care Products

• Tampons
• Pads
• Liners
• Cups
• Sponges

Dental Expenses

• Braces and orthodontic services
• Cleanings
• Crowns
• Deductibles, co-insurance
• Dental implants
• Dentures, adhesives
• Fillings

For the Disabled

• Automobile equipment and installation costs for a disabled person in excess of the cost of an ordinary automobile; device for lifting a mobility impaired person into an automobile
• Braille books/magazines in excess of cost of regular editions
• Note-taker for a hearing impaired child in school
• Seeing eye dog (buying, training, and maintaining)
• Special devices, such as a tape recorder or typewriter for a visually impaired person
• Visual alert system in the home or other items such as a special phone required for a hearing impaired person
• Wheelchair or autoette (cost of operating/maintaining)

Requiring Additional Documentation

The following expenses are eligible only when incurred to treat a diagnosed medical condition. Such expenses require a
Letter of Medical Necessity from your physician, containing the medical necessity of the expense, diagnosed condition,
onset of condition, and physician’s signature.

• Ear plugs
• Massage treatments
• Nursing services for care of a special medical ailment
• Orthopedic shoes (excess cost of ordinary shoes)
• Oxygen equipment and oxygen
• Support hose
• Varicose vein treatment
• Veneers
• Vitamins and supplements
• Wigs (for mental health condition of individual who loses hair because of a disease)

Dependent Care Expenses

• Day camp (primary purpose must be custodial care and not educational in nature)
• Dependent care expenses that are necessary for you (and your spouse) to work, actively look for work, or attend school full-time
• Dependent care for children under the age of 13 or for elderly dependents who reside with you
• FICA/FUTA taxes of day care provider
• Late pick-up fees
• Nanny expenses attributed to dependent care
• Nursery school (preschool)
• Registration fees (allocated to dependent care services)

Does not cover medical costs; use Healthcare FSA for medical expenses incurred by you or your dependents.

Ineligible Medical Expenses

• Athletic mouth guards
• Auto insurance providing medical coverage
• Chapstick/lip balm
• Contributions to state disability funds
• Cosmetic surgery, dentistry, or other cosmetic procedures
• Cosmetic supplies (makeup, cleansers, moisturizers, etc.)
• Deodorant
• Dental floss
• Diaper service
• Diet (cost of special foods taken as substitute for regular diet)
• Dietary and fiber supplements Divorce (when recommended by doctor or psychiatrist)
• Distilled water purchased to avoid drinking fluoridated city water or for use in medical equipment
• Domestic help (companion, babysitter, chauffeur who primarily renders services of a non-medical nature)
• Electrolysis/hair removal
• Exercise equipment and fees
• Eye drops for general comfort
• Eyeglass cases
• Hand sanitizer
• Health club or athletic club membership fees
• Herbal supplements
• Illegal treatment or medication
• Insurance premiums, all types
• Lanyards
• Lotions or skin moisturizers
• Marriage counseling
• Maternity clothes
• Mattress
• Medicare premiums
• Medicated shampoos, conditioners, and soaps
• Mobile telephone used for personal and physician calls
• Nursemaids or practical nurses who render general care for healthy infants
• Pajamas/slippers purchased to wear in hospital
• Personal use items (toothbrush, pillow, shampoo, mattress, etc.)
• Physical treatment unrelated to specific health problems (massage for general well-being, stress, depression, or chiropractic wellness)
• Premiums for coverage through other medical plans (spouse’s employer-sponsored plan or individual plan)
• Safety glasses (non-prescription)
• Special foods purchased to replace nutrition or for general health needs (such as diet foods)
• Sunglasses (nonprescription) and sun clips
• Teeth whitening products
• Toiletries
• Toothbrush (includes prescribed electric ones) and toothpaste
• Vacuum cleaner purchased by an individual with dust allergy
• Vitamins and supplements for well-being
• Warranties
• Weight loss drugs/programs for general well being