Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: S

For the FSAFEDS HCFSA and LEX HCFSA, services listed in this document as eligible (or that meet the "potentially eligible" requirements) are eligible for reimbursement, if the services are:

rendered by a health care professional appropriately licensed or certified in the state in which he or she practices; and
performed within the scope of the health care professional's license.

For the FSAFEDS DCFSA, services listed in this document as eligible (or that meet the "potentially eligible" requirements) are eligible for reimbursement, if the services are:

for an individual you claim as a dependent on your Federal Tax return who is under 13 or incapable of self-care; and
necessary to allow you and your spouse, if married, to work, look for work or attend school full-time.

*Please note, all "potentially eligible health care expenses" require a letter of medical necessity from your health care provider in order to be considered eligible for reimbursement. The letter must include the diagnosis or symptoms for which you, your spouse, dependent or adult child through age 26 are being treated, along with specific information on how the product or service is intended to alleviate symptoms or improve function. Submitting a LMN for your claim does not guarantee that the expense will be reimbursed. You must submit a new LMN each year if the medical condition persists - they cannot be approved indefinitely.

As of January 1, 2011 eligible over-the-counter (OTC) products that are medicines or drugs (e.g., acne treatments, allergy and cold medicines, antacids, etc.) will only be eligible for reimbursement from your Health Care FSA with a physician's prescription that includes his or her address and license number, as stated in IRS Notice 2010-59. The only exception is insulin - which will not require a prescription. OTC products or items that are not considered medicines or drugs, such as bandages and nasal strips, will continue to be eligible without a prescription. For information on submitting OTC expenses, see the OTC Quick Reference Guide.

Condition/Type of Service/Expense	Account Type	Eligible Expense	Potentially Eligible Expense*	OTC Prescription Required	Not Eligible	Additional Information
SALES TAX	HCFSA					See TAXES
SCOOTERS (Coverage Code 104)	HCFSA		X
SERVICE ANIMALS (Coverage Code 104)	HCFSA	X				Expenses to train or procure any guide dog, signal dog, or other animal individually trained to provide assistance to you, your spouse or dependent with a disability can be reimbursed under a HCFSA. Expenses such as food, medications, vet visits, and dental care products needed for the care or maintenance of service animals are eligible expenses. Please note, you must provide documentation to support the expense is for an actual service animal.
SHAMPOO, medicated (Coverage Code 117)	HCFSA		X	X		May be eligible when used to treat a specific medical condition. Examples include: Denorex DHS Tar Shampoo Nizoral A Letter of Medical Necessity (LMN) from your physician must be signed by your health care practitioner, state your medical diagnosis, the name of the medicated shampoo that will treat the medical diagnosis and specify the length of time the medicated shampoo is required. Please note, this does not include cosmetic-type shampoos.
SHIPPING AND HANDLING (Coverage Code 104)	HCFSA	X				Shipping and handling charges for medical needs, such as mail-order prescriptions and eligible over-the-counter items.
SHOWER CHAIRS (Coverage Code 104)	HCFSA	X
SITZ BATH (Coverage Code 104)	HCFSA	X
SLEEP AIDS (Coverage Code 117)	HCFSA			X		Examples include: Nytol Sominex Tylenol PM Unisom For more information on submitting OTC expenses, see the OTC Quick Reference Guide.
SMOKING CESSATION MEDICINES (Coverage Code 117)	HCFSA			X		Examples include: Commit Nicoderm CQ Nicorette Nicotrol For more information on submitting OTC expenses, see the OTC Quick Reference Guide.
SMOKING CESSATION PROGRAMS (Coverage Code 104)	HCFSA	X
SPECIAL EDUCATION AND SCHOOLS (Coverage Code 104)	HCFSA		X			See LEARNING DISABILITIES
SPECIAL FOODS (Coverage Code 104)	HCFSA		X			If prescribed by a physician to treat a special illness or ailment, and not merely as a substitute for normal nutritional requirements. The amount that can be reimbursed is limited to the amount that the special food exceeds the cost of commonly available versions of the same product.
SPECIALIZED EQUIPMENT OR SERVICES (Coverage Code 104)	HCFSA					See ADAPTIVE EQUIPMENT
SPEECH THERAPY (Coverage Code 104)	HCFSA	X
SPERM STORAGE (Coverage Code 104)	HCFSA		X			Storage fees can be reimbursed if you, your spouse or dependent has a cancer or blood dyscrasia diagnosis that requires chemotherapy or whole body radiation which may affect future ability to conceive children. NOTE: Storage fees should not exceed 12 months. If you pre-pay for 12 months, you may only be reimbursed when the expenses have been incurred. The amount can be pro-rated in order to file claims for reimbursement after services are rendered.
STERILIZATION PROCEDURES (Coverage Code 104)	HCFSA	X
STERILIZATION REVERSAL (Coverage Code 104)	HCFSA	X
STUDENT HEALTH FEE	HCFSA				X
SUBSTANCE ABUSE (Coverage Code 104)	HCFSA	X				See ALCOHOLISM
SUBWAY FARE (Coverage Code 104)	HCFSA	X				See TRANSPORTATION
SUNBURN/BURN RELIEF (Coverage Code 102)	HCFSA	X				Examples include: Aloe Vera Solarcaine For more information on submitting OTC expenses, see the OTC Quick Reference Guide.
SUN-PROTECTIVE CLOTHING (Coverage Code 104)	HCFSA		X			Clothing that offers at least 30+ UVA and UVB sun protection for individuals with melanoma or other skin cancer, systemic lupus erythematosus (SLE), acute cutaneous lupus (ACLE) or other significant dermatologic conditions may be eligible with a letter of medical necessity from your doctor. The clothing is reimbursed for the difference between “normal” apparel and this specially-constructed clothing up to 33% of the total cost. The receipt must show the purchase was from an accredited sun-protective company such as Solumbra® or Coolibar®.
SUNSCREEN (Coverage Code 102)	HCFSA	X				Sunscreen products with an SPF 30 or higher are eligible. Lotions or cosmetics that contain ingredients to protect you from the sun and/or list a SPF are not eligible. For more information on submitting OTC expenses, see the OTC Quick Reference Guide.
SURROGACY EXPENSES (Coverage Code 104)	HCFSA	X				Surrogacy expenses can be reimbursed only if the FSAFEDS participant is the surrogate.
SWIM/SKI GOGGLES, PRESCRIPTION	HCFSA				X

PLEASE NOTE: Eligible expenses listed here are subject to change without notice.