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Know Your FSA Eligible and Ineligible Expenses

Use Your Health Care FSA Wisely
The Flexible Spending Account (FSA) is an IRS sanctioned benefit that al ows you to use pretax dol ars to cover eligible expenses. The IRS defines eligible health care expenses as amounts paid for the diagnosis, cure, mitigation or treatment of a disease, and for treatments affecting any part or function of the body. The expenses must be primarily to alleviate a Take a look at the fol owing lists for a better understanding of what is and isn’t eligible. Other expenses not specifical y mentioned may also qualify (for additional information, please contact your Plan Administrator). Eligible Expenses
BABY/CHILD TO AGE 13
MEDICAL EQUIPMENT/SUPPLIES
MEDICATION
OBSTETRICS
PRACTITIONERS
MEDICAL PROCEDURES/SERVICES
(inpatient and outpatient treatment)  Homeopath or Naturopath* LAB EXAMS/TESTS
 Sterilization/Sterilization Reversal Note: This list is not meant to be all-inclusive. Also, expenses marked with an asterisk (*) are “potentially eligible expenses” that require a Note of Medical Necessity from your health care provider to qualify for reimbursement. Over-the-Counter Items Now through 12/31/2010
The IRS allows certain over-the-counter (OTC) medicines to be reimbursed using your FSA dollars. Here is a brief listing of some of those items: Eligible Over-the-Counter Items
Medications, First Aid Kits, Gauze, Gloves,  Toothache and Teething Pain Relievers  Weight Loss Drugs (to treat a specific Blood Test Strips, Glucose Food, Glucose Check your plan document or
Plan Administrator’s website for
more information.
 Homeopathic Medicines*  Incontinence Supplies
Over-the-Counter Items Effective 1/1/2011
Employees with an FSA can no longer use their account funds to purchase OTC drugs and medicines (e.g. Advil, ibuprofen, cough syrup) unless they have a Note of Medical Necessity (NMN) or a prescription from their If an employee has an NMN or a prescription for an OTC drug or medicine, they must pay at the point of service and submit a manual claim for reimbursement. Employees can continue to use their FSA funds to purchase OTC items that are not considered a drug or a medicine (e.g. bandages, wound care, contact lens solution). Benefits cards can continue to be used for these
purchases.
Ineligible Expenses
The IRS does not al ow the fol owing expenses to be reimbursed under FSAs, as they are not prescribed by a Note: This list is not meant to be all-inclusive. Also, expenses marked with an asterisk (*) are “potentially eligible expenses” that require a Note of Medical Necessity from your health care provider to qualify for reimbursement. Ineligible Expenses
 Baby-sitting and Child Care*
 Vitamins or Nutritional Supplements*
For additional information, please contact your human resources department or Plan Administrator.
This document is confidential to Evolution Benefits, Inc. and may not be used, copied or disclosed except with express prior written

Source: http://vernonpublicschools.org/files/HR-Insurance-FSA-DCA/Eligible%20%26%20Ineligible%20Expenses.pdf