Scheduling: 972-612-6525 Fax: 469-484-2326 Diagnosis (All test/procedures ordered must have a diagnosis and reason for testing) Physician's Signature (required for order) To request radiology images or reports contact us at 972-566-7226 3-D Reformation BILATERAL Fluoroscopy Nuclear Medicine Radiology Rapidscreen Chest CAD will be completed on all
- A |
J |K |
U |V |
Tc-3496-022811 tasc guide to deductible expense.inddOTC Items That Require Prescription or
Prescription Order Form
In March 2010, the Patient Protection and Aff ordable Care Act medicine or drug is a prescribed drug (determined without regard (PPACA) amended previous legislated defi nitions of which to whether such drug is available without a prescription) or is over-the-counter (OTC) healthcare expenses are eligible for tax- advantaged benefi t plans such as Flexible Spending Accounts, Health Reimbursement Arrangements, and Health Savings Below is a partial list of over-the-counter items that will require a Accounts. The language made the current defi nition very clear, prescription or a Prescription Order Form to be an eligible expense “reimbursement for expenses incurred for a medicine or drug shall be treated as a reimbursement for medical expenses only if such Type of OTC Drug
Benadryl, Sudafed, Claritin, Alavert, Chlora Trimaton Tums, Gas-X, Maalox, Mylanta, Pepcid AC, Prilosec OTC Monistat 3, 7, Femstat 3, Gyne-Lotrimin, Vagistat-1 Benadryl, Sudafed, Actifed, Contac, Tylenol Cold, Nyquil, Triaminic, Claritin Pepto-Bismol, Immodium AD, Ex-Lax, Correctol Bactine, Cortaid, Lanacort, Benadryl Cream, Caladryl, Calamine Lotion Mucinex, Robitussin, Vicks 44, Chloraseptic Decongestant/nasal decongestant and cold remedies Tylenol Cold and Flu, Advil Cold and Sinus, Tavist-D, Thera-Flu, Alka Seltzer Cold and Flu, Sudafed, Nyquil, Dristan Long Lasting, Neo-Synephrine Internal analgesic/antipyretic (pain relief ) Tylenol, Aleve, Advil, Excedrin, Bayer, Ecotrin, Children’s Motrin, St. Joseph’s Children’s Aspirin Excedrin Migraine, Advil Migraine, Motrin Migraine TASC • 2302 International Lane • Madison, WI 53704-3140 • 1-800-422-4661 • Fax: 608-245-3623 The information in this communication is confi dential and may only be used by the authorized recipient for its intended purpose. Any other use or disclosure is prohibited.
OTC Items That Require Prescription or
Prescription Order Form
Type of OTC Drug
Nicotine gum, patches, or other smoking cessation aids Compound W, Dr. Scholl’s Clear Away, Wartner TASC • 2302 International Lane • Madison, WI 53704-3140 • 1-800-422-4661 • Fax: 608-245-3623 The information in this communication is confi dential and may only be used by the authorized recipient for its intended purpose. Any other use or disclosure is prohibited.
Deductible Medical Expenses
Medical Care means amounts paid for the diagnosis, cure, Christian science fees, if related to a medical condition.
mitigation, treatment or prevention of disease, and/or for treatments aff ecting any part or function of the body. The Cold/hot packs, if used to treat a medical condition.
medical care expense must be primarily to alleviate or prevent a physical or mental defect or illness.
Contact lenses, materials and suppliesCounseling, if related to a medical condition.
The following list identifi es expenses that may be reimbursed under the products off ered by TASC. This list includes a partial list of over-the-counter items that remain eligible and need no Abortion, expenses for operations that are illegal do not Administrative costs, FSA monthly maintenance fees qualify.
Air conditioner, must be recommended by a Doctor to treat a Eggs and embryos, storage fees. Temporary storage qualify, but Air purifi er, must be recommended by a Doctor to treat a specifi c only to the extent necessary for immediate conception.
fees for undefi ned future conception likely are not considered Alternative healers, must be needed to treat a medical condition.
Elevator, may qualify if a medical condition is present. See capitol Automobile modifi cation, if for a physically handicapped person.
Bandages & fi rst aid dressingsBirth control products Family member’s transportation where presence of family member is necessary to obtain medical care.
Food, organic, the excess cost for person allergic to chemically Braille books and magazines, if for a visually impaired person, but only amounts above the cost of regular printed material will Breast pumps and supplies that assist lactationBreast reconstruction surgery following mastectomy, to the extent the surgery was related to cancer.
Capitol expenses, improvements or special equipment added to a home or other capital expenditures may qualify if the primary purpose of the expenditure is medical care. How much of the expense would qualify depends on the extent to which the expense permanently improves the property and whether others besides the person with the medical condition will TASC • 2302 International Lane • Madison, WI 53704-3140 • 1-800-422-4661 • Fax: 608-245-3623 The information in this communication is confi dential and may only be used by the authorized recipient for its intended purpose. Any other use or disclosure is prohibited.
Deductible Medical Expenses
Lamaze classes, qualify to the extent that the instruction relates Language training, if related to a medical condition.
Lead based paint removal, for the costs of removing lead based Propecia, must be used to treat a specifi c medical condition such paints from surfaces in the participant’s home.
as propecia ameliorates a deformity arising from congenital abnormality, personal injury from accident or trauma. Is not a Legal fees, general, may qualify as medical care if they bear a qualifi ed expense if used for cosmetic reason.
direct or proximate relationship to the provision of medical care to the participant, the spouse or dependent.
Lodging, while away from the home primarily for and essential to medical care, $50/night per individual.
Massage therapy, if related to a medical condition.
Meals, that are provided at a hospital or similar institution at Retin-A, must be used to treat a medical condition and not which the patient is receiving medical care.
Rogaine, only is used to treat a medical condition and not for Medical conference admission, transportation, meals, etc. Expenses for admission and transportation, if they relate to a medical condition for the individuals, spouse and/or dependent and if the conference is primarily for and essential Schools and education, special. Payments made to a special to the person in need of medical care.
school for a mentally impaired or physically disabled person Medical information plan charges. To cover storage costs. qualify if the main reason for using the school is its resources These are expenses paid to a plan to keep medical information so that it can be retrieved from a computer databank for your Medical monitoring (medical bracelets) and testing devices Shipping and handling fees, must be associated to fees Medical records charges, for example, fees associated with incurred to obtain an item that constitutes medical care.
transferring medical records to a new medical practitioner will Special foods, if prescribed my a medical practitioner to treat a specifi c illness or ailment and if the foods do not substitute for normal nutritional requirements. But the amount that may qualify is limited to the amount by which the cost of the special food exceeds the cost of commonly available versions Sperm, storage fees, yes with respect to temporary storage, but only to the extent necessary for immediate conceptions. Storage fees for undefi ned future conception likely are not considered Orthopedic shoes and inserts, cost of specialized orthopedic items qualify to the extent that they exceed the ordinary Stem cell harvesting and/or storage of. Yes, if there is a specifi c and imminent medical condition that the stem cells are intended to treat. An example would be the cost of harvesting and storing stem cells because a newborns has a birth defect TASC • 2302 International Lane • Madison, WI 53704-3140 • 1-800-422-4661 • Fax: 608-245-3623 The information in this communication is confi dential and may only be used by the authorized recipient for its intended purpose. Any other use or disclosure is prohibited.
Deductible Medical Expenses
and the stem cells would be needed in the near future are Examples of Non-Qualifi ed Medical
allowable. Collection and storage indefi nitely is not medical Expenses:
Sterilization proceduresSunglasses, yes if they are prescription sunglasses Automobile depreciation, insurance repair or maintenance expenses Taxes on medical services, to the extent that the tax is impose on qualifi ed medical care expenses. This includes local, sales, service and other taxes.
Telephone for hearing impaired persons ThermometersTransportation expenses for person to receive medical care. Illegal operations, treatments and medicines This is limited to the standard mileage allowance.
Late fees, for late payment of bills for medical careLodging while attending a medical conference Ultrasound, prenatalUmbilical cord, freezing and storing of, if there is a specifi c medical condition that the umbilical cord is intended to treat. Collection and storage indefi nitely, just in case it is needed is Transportation to visit a hospitalized spouse or dependent Warranties, extended warranties, maintenance agreements VaccinesVasectomyVasectomy, reversalViagra, if used to treat a medical condition.
Vision correction procedures WalkersWeight loss program, only if the program is recommended by a physician to treat an existing disease (such as obesity, heart disease or diabetes) and is not simply to improve general health.
WheelchairWigs, if the wig is prescribed by a physician for the mental heath of a patient who has lost all of their hair from disease or treatment.
TASC • 2302 International Lane • Madison, WI 53704-3140 • 1-800-422-4661 • Fax: 608-245-3623 The information in this communication is confi dential and may only be used by the authorized recipient for its intended purpose. Any other use or disclosure is prohibited.
Say ‘No’ to Drugs - Taiwan’s Anti-drug Response The “ECHINACEA CAMPAIGN” The Ministry of Education The Republic of China (Taiwan) President Ma Ying-jeou, in his June 2, 2012 announcement regarding Taiwan’s most recent efforts to respond to societal drug use, called on the people to actively educate themselves about the effects of illegal drugs and to support Taiwan