Eligible Expenses Juke Box

FSAFEDS Eligible Expenses: V

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*	Not Eligible	Additional Information
VASECTOMY (Coverage Code 104)	HCFSA	X
VASECTOMY REVERSAL (Coverage Code 104)	HCFSA	X			See STERILIZATION REVERSAL
VIAGRA (Coverage Code 103)	HCFSA	X
VISION CARE (Coverage Code 303)	HCFSA LEX HCFSA	X			Expenses such as eye exams, vision correction procedures, vision therapy and glasses or contact lenses are eligible.
VISION DISCOUNT PROGRAMS	HCFSA LEX HCFSA			X	Fees paid to gain access to a vision network, or to a reduced fee structure are not an eligible expense under a HCFSA. See INSURANCE PREMIUMS
VITAMIN B-12 INJECTIONS (Coverage Code 104)	HCFSA		X
VITAMINS (Coverage Code 102)	HCFSA		X		Vitamins, dietary, nutritional and herbal supplements, and natural medicines are not reimbursable if they are merely taken for general health. However, they may be eligible if recommended by a medical practitioner to treat a specific medical condition.
VITAMINS, PRE-NATAL (Coverage Code 102)	HCFSA	X

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