|
Standard
FSA
|
Limited FSA or
HSA-Compatible
| |
| 01 - Rx (prescription) |
Yes
|
No
| |
| 02 - Co-payment (medical) |
Yes
|
No
| |
| 03 - Office visit (medical) |
Yes
|
No
| |
| 04 - Dental |
Yes
|
Yes
| |
| 05 - Over-the-counter (drugs and medicines) |
|
No
| |
| 06 - Contact lenses and solutions |
Yes
|
Yes
| |
| 07 - Vision |
Yes
|
Yes
| |
| 08 -Psych / therapy |
Yes
|
No
| |
| 09 - Chiropractic care |
Yes
|
No
| |
| 10 - Lab (medical) |
Yes
|
No
| |
| 11 - Orthodontia |
Yes
|
Yes
| |
| 12 - Hospital fees |
Yes
|
No
| |
| 13 - X-ray (medical) |
Yes
|
No
| |
| Acne treatments (over-the-counter) |
|
No
| |
| Acupuncture |
Yes
|
No
| |
| Adoption (medical expenses related to) |
Yes
|
No
| |
| Adoption fees |
No
|
No
| |
| Alcoholism treatment |
Yes
|
No
| |
| Allergy and sinus medicine and products (over-the-counter) |
|
No
| |
| Allergy medication |
|
No
| |
| Allergy treatments and products |
|
No
| |
| Alternative dietary supplements (for treatment of a medical condition) |
|
No
| |
| Alternative drugs, medicines and treatment products (for treatment of a medical condition) |
|
No
| |
| Alternative healers (for treatment of a medical condition) |
|
No
| |
| Ambulance and emergency health services |
Yes
|
No
| |
| Anesthesia (for non-cosmetic purposes) |
Yes
|
No
| |
| Antacid (over-the-counter) |
|
No
| |
| Antibiotic ointment (over-the-counter) |
|
No
| |
| Aspirin or other pain reliever (over-the-counter) |
|
No
| |
| Asthma medicines or treatments (over-the-counter) |
|
No
| |
| Athletic treatments / braces |
Yes
|
No
| |
| Bandages and related items (over-the-counter) |
Yes
|
No
| |
| Birth control (over-the-counter) |
|
No
| |
| Birth control (prescription or other) |
Yes
|
No
| |
| Blood pressure monitor |
Yes
|
No
| |
| Body scans |
Yes
|
No
| |
| Braille books and magazines (difference in cost only) |
Yes
|
Yes
| |
| Breastfeeding classes |
Yes
|
No
| |
| Breast pump (for a lactating woman) |
Yes
|
No
| |
| Breast reconstruction surgery (following mastectomy) |
|
No
| |
| COBRA premiums (dental; paid with after-tax dollars only) |
No
|
No
| |
| COBRA premiums (medical; paid with after-tax dollars only) |
No
|
No
| |
| COBRA premiums (other; paid with after-tax dollars only) |
No
|
No
| |
| COBRA premiums (prescription; paid with after-tax dollars only) |
No
|
No
| |
| COBRA premiums (vision; paid with after-tax dollars only) |
No
|
No
| |
| Cancer (fixed indemnity) insurance premiums |
No
|
No
| |
| Canker and cold sore treatments (over-the-counter) |
|
No
| |
| Car modifications (as required for a medical condition diagnosed by a licensed health care professional) |
|
No
| |
| Chest rubs (over-the-counter) |
|
No
| |
| Child or newborn care instruction |
No
|
No
| |
| Childbirth classes (charges for mother only) |
Yes
|
No
| |
| Chiropractic office visit or treatment |
Yes
|
No
| |
| Christian Science practitioners |
Yes
|
No
| |
| Cholesterol test kits and supplies |
Yes
|
No
| |
| Co-insurance (dental) |
Yes
|
Yes
| |
| Co-insurance (medical) |
Yes
|
No
| |
| Co-insurance (prescription) |
Yes
|
No
| |
| Co-insurance (vision) |
Yes
|
Yes
| |
| Co-payment (dental) |
Yes
|
Yes
| |
| Co-payment (medical) |
Yes
|
No
| |
| Co-payment (other) |
Yes
|
No
| |
| Co-payment (vision) |
Yes
|
Yes
| |
| Cold and flu medicine (over-the-counter) |
|
No
| |
| Cold cream (over-the-counter) |
No
|
No
| |
| Compression or anti-embolism socks, stockings or hose |
|
No
| |
| Concierge medical fees (billed for actual services received) |
Yes
|
No
| |
| Concierge medical fees (billed for future availability of services, with no services actually received) |
No
|
No
| |
| Condoms |
Yes
|
No
| |
| Contraceptives (prescription) |
Yes
|
No
| |
| Contraceptives (over-the-counter) |
|
No
| |
| Cord blood storage (for future treatment of a birth defect or known medical condition) |
|
No
| |
| Cord blood storage (for unidentified future use) |
No
|
No
| |
| Corn and callus remover (over-the-counter) |
|
No
| |
| Corneal keratotomy |
Yes
|
Yes
| |
| Cosmetic procedures or surgery |
No
|
No
| |
| Cosmetic procedures or surgery for birth defects, accidents, and/or disease |
|
No
| |
| Cough drops and sore throat lozenges (over-the-counter) |
|
No
| |
| Cough syrup (over-the-counter) |
|
No
| |
| Counseling (for treatment of a medical condition) |
Yes
|
No
| |
| Counseling (marriage) |
No
|
No
| |
| CPR classes (adult or child) |
No
|
No
| |
| Crutches, canes, walkers or like equipment (purchase or rental) |
Yes
|
No
| |
| Dancing lessons (for treatment of a medical condition) |
|
No
| |
| Deductible for dental plan |
Yes
|
Yes
| |
| Deductible for medical plan |
Yes
|
No
| |
| Deductible for prescription plan |
Yes
|
No
| |
| Deductible for vision plan |
Yes
|
Yes
| |
| Dental care (for non-cosmetic purposes, including sealants) |
Yes
|
Yes
| |
| Dental co-insurance |
Yes
|
Yes
| |
| Dental co-payment |
Yes
|
Yes
| |
| Dental insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Dental products for general health |
No
|
No
| |
| Dental reconstruction (including implants) |
Yes
|
Yes
| |
| Dental veneers |
|
| |
| Dentures, bridges, etc. |
Yes
|
Yes
| |
| Dermatology treatments and products |
|
No
| |
| Diabetic monitors, test kits, strips and supplies |
Yes
|
No
| |
| Diagnostic services (other than dental or vision) |
Yes
|
No
| |
| Diagnostic services (dental or vision) |
Yes
|
Yes
| |
| Diaper rash ointments and creams |
|
No
| |
| Diapers and diaper services |
No
|
No
| |
| Dietary supplements (for treatment of a medical condition) |
|
No
| |
| Doula or birthing coach |
|
No
| |
| Drug addiction treatment |
Yes
|
No
| |
| Drugs (imported) |
No
|
No
| |
| Drugs (prescription) |
Yes
|
No
| |
| Dyslexia treatment |
|
No
| |
| Ear drops and wax removal (over-the-counter) |
|
No
| |
| Electrolysis |
No
|
No
| |
| Emergency kits (over-the-counter) |
No
|
No
| |
| Exercise equipment or program (as treatment for a medical condition diagnosed by a licensed health care professional) |
|
No
| |
| Eye drops and treatments (over-the-counter) |
|
| |
| Eye examinations |
Yes
|
Yes
| |
| Eye related equipment/materials |
Yes
|
Yes
| |
| Eye surgery or treatment to correct vision |
Yes
|
Yes
| |
| Eyeglasses (over-the-counter) |
Yes
|
Yes
| |
| Eyeglasses (prescription) |
Yes
|
Yes
| |
| Face lifts |
No
|
No
| |
| Feminine hygiene products |
No
|
No
| |
| Fertility monitor (over-the-counter) |
Yes
|
No
| |
| Fertility treatment (for employee, spouse or dependent) |
Yes
|
No
| |
| Fertility treatment (for non-dependent surrogate) |
No
|
No
| |
| First aid kits (over-the-counter) |
Yes
|
No
| |
| Fitness programs (as treatment for a medical condition diagnosed by a licensed health care professional) |
|
No
| |
| Flu shots |
Yes
|
No
| |
| Funeral expenses |
No
|
No
| |
| Gastrointestinal medication (over-the-counter) |
|
No
| |
| Guide dog (dog, training, care) |
Yes
|
Yes
| |
| Hair regrowth products |
No
|
No
| |
| Hair removal |
No
|
No
| |
| Hair transplant |
No
|
No
| |
| Hair treatments |
No
|
No
| |
| Hand lotion (over-the-counter) |
No
|
No
| |
| Health club dues (as treatment for a medical condition diagnosed by a licensed health care professional) |
|
No
| |
| Health insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Health savings account (HSA) contributions |
No
|
No
| |
| Hearing aids and batteries |
Yes
|
No
| |
| Herbal or homeopathic medicines (over-the-counter) |
|
No
| |
| Home improvements (as required for a medical condition diagnosed by a licensed health care professional) |
|
No
| |
| Hospital (fixed indemnity, $x per day) insurance premiums |
No
|
No
| |
| Hospital services and fees |
Yes
|
No
| |
| Household help |
No
|
No
| |
| Humidifier, air filter and supplies |
|
No
| |
| Illegal operations or substances |
No
|
No
| |
| Immunizations |
Yes
|
No
| |
| Incontinence supplies |
Yes
|
No
| |
| Individual dental insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Individual insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Individual medical insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Individual prescription insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Individual vision insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Infertility treatment (for employee, spouse or dependent) |
Yes
|
No
| |
| Insulin, testing materials and supplies |
Yes
|
No
| |
| Insurance or health insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Insurance / plan premiums (paid with pre-tax dollars) |
No
|
No
| |
| Laboratory fees |
Yes
|
No
| |
| Lactose intolerance (over-the-counter) |
|
No
| |
| Lamaze classes (charges for mother only) |
Yes
|
No
| |
| Laser eye surgery |
Yes
|
Yes
| |
| Lasik |
Yes
|
Yes
| |
| Late payment fees charged by health care provider |
No
|
No
| |
| Laxatives (over-the-counter) |
|
No
| |
| Learning disability treatments |
Yes
|
No
| |
| Lice treatment (over-the-counter) |
|
No
| |
| Listening therapy |
Yes
|
No
| |
| Lodging (limited to $50 per night for patient to receive medical care and $50 per night for one caregiver) |
|
No
| |
| Long-term care premiums (up to IRS tax-free limit, see IRS Publication 502) |
No
|
No
| |
| Long-term care services |
No
|
No
| |
| Long-term disability insurance premiums |
No
|
No
| |
| Magnetic therapy (over-the-counter) |
|
No
| |
| Massage therapy (for treatment of a medical condition) |
|
No
| |
| Mastectomy-related special bras |
Yes
|
No
| |
| Maternity clothes |
No
|
No
| |
| Medical abortion |
Yes
|
No
| |
| Medical co-insurance |
Yes
|
No
| |
| Medical co-payment |
Yes
|
No
| |
| Medical equipment (for treatment of medical condition) and repairs |
Yes
|
No
| |
| Medical insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Medical literature, books, pamphlets or audio |
No
|
No
| |
| Medical monitoring and testing devices |
Yes
|
No
| |
| Medical records charges |
Yes
|
No
| |
| Medical savings account (MSA) contributions |
No
|
No
| |
| Medical supplies (for treatment of a medical condition) |
Yes
|
No
| |
| Medicare alternative insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Medicare Part B insurance |
No
|
No
| |
| Medicare alternative insurance / plan premiums (vs. Part A & Part B, paid with after-tax dollars only) |
No
|
No
| |
| Medicare supplement policy premiums |
No
|
No
| |
| Medicines (over-the-counter) |
|
No
| |
| Medicines (prescription) |
Yes
|
No
| |
| Midwife |
Yes
|
No
| |
| Mileage (for travel to / from anything other than eligible care) |
No
|
No
| |
Mileage
(for travel to / from eligible health care) |
Yes
|
No
| |
| Modified equipment (difference in cost only) |
|
No
| |
| Monitors and test kits (over-the-counter) |
Yes
|
No
| |
| Motion and nausea |
|
No
| |
| Nasal sprays |
|
No
| |
| Nasal strips (over-the-counter) |
|
No
| |
| No show fees charged by health care provider |
No
|
No
| |
| Non-prescription drugs and medicines (for non-cosmetic purposes) |
|
No
| |
| Norplant insertion or removal |
Yes
|
No
| |
| Nursing services (wages and taxes) |
Yes
|
No
| |
| Nutritional supplements (for treatment of a medical condition) |
|
No
| |
| OB/GYN fees |
Yes
|
No
| |
| Occlusal guards to prevent teeth grinding |
Yes
|
Yes
| |
| Occupational therapy (related to a medical condition or disability) |
Yes
|
No
| |
| Office visits (chiro) |
Yes
|
No
| |
| Office visits (dental) |
Yes
|
Yes
| |
| Office visits (medical) |
Yes
|
No
| |
| Office visits (psych/therapy) |
Yes
|
No
| |
| Office visits (vision) |
Yes
|
Yes
| |
| Operations (for non-cosmetic purposes) |
Yes
|
No
| |
| Operations (for vision and dental only) |
Yes
|
Yes
| |
| Optometrist / ophthalmologist fees |
Yes
|
Yes
| |
| Organ transplants (recipient and donor) |
Yes
|
No
| |
| Orthotics |
Yes
|
No
| |
| Ortho keratotomy |
Yes
|
Yes
| |
| Orthodontia (braces and retainers) |
Yes
|
Yes
| |
| Orthopedic and surgical supports |
Yes
|
No
| |
| Orthopedic shoes and inserts (difference in cost only of specialized orthopedic shoe over like non-specialized shoe) |
|
No
| |
| Over-the-counter acne treatments |
|
No
| |
| Over-the-counter allergy and sinus medicine |
|
No
| |
| Over-the-counter antacid |
|
No
| |
| Over-the-counter antibiotic ointment |
|
No
| |
| Over-the-counter aspirin or other pain reliever |
|
No
| |
| Over-the-counter asthma medicines or treatments |
|
No
| |
| Over-the-counter bandages and related items |
Yes
|
No
| |
| Over-the-counter canker and cold sore treatments |
|
No
| |
| Over-the-counter chest rubs |
|
No
| |
| Over-the-counter cold and flu medicine |
|
No
| |
| Over-the-counter cold and flu prevention |
|
No
| |
| Over-the-counter cold cream |
No
|
No
| |
| Over-the-counter cough drops and sore throat lozenges |
|
No
| |
| Over-the-counter cough syrup |
|
No
| |
| Over-the-counter health care products (eligible) |
|
No
| |
| Over-the-counter health care products (not eligible) |
No
|
No
| |
| Over-the-counter medication (including for motion sickness, sleep aids and sedatives) |
|
No
| |
| Over-the-counter products for dental, oral and teething pain |
|
| |
| Over-the-counter products for general dental care |
No
|
No
| |
| Over-the-counter vision products |
Yes
|
Yes
| |
| Ovulation monitor (over-the-counter) |
Yes
|
No
| |
| Oxygen |
Yes
|
No
| |
| Pain reliever (over-the-counter) |
|
No
| |
| Parental fees (billed for actual services received; for disabled children) |
Yes
|
No
| |
| Parental fees (billed for future availability of services, with no services actually received; for disabled children) |
No
|
No
| |
| Personal use items (toothbrush, toothpaste, etc.) |
No
|
No
| |
| Physical exams |
Yes
|
No
| |
| Physical therapy |
Yes
|
No
| |
| Physician retainer fee (for on-call or concierge services) |
No
|
No
| |
| Pregnancy tests (over-the-counter) |
Yes
|
No
| |
| Prescription co-insurance |
Yes
|
No
| |
| Prescription co-payment |
Yes
|
No
| |
| Prescription drugs (for non-cosmetic purposes) |
Yes
|
No
| |
| Prescription drugs for cosmetic purposes |
No
|
No
| |
| Prescription drugs for hair regrowth |
No
|
No
| |
| Prescription insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Propecia (for treatment of a medical condition) |
|
No
| |
| Prosthesis |
Yes
|
No
| |
| Psychiatric care |
Yes
|
No
| |
| Psychoanalysis |
Yes
|
No
| |
| Psychologist fees |
Yes
|
No
| |
| Radial keratotomy (RK) |
Yes
|
Yes
| |
| Reading glasses (over-the-counter) |
Yes
|
Yes
| |
| Reconstructive surgery (following accident or medical procedure or condition) |
|
No
| |
| Removal of benign mole, cyst or tumor |
Yes
|
No
| |
| Retainer fee (to physician for on-call or concierge services) |
No
|
No
| |
| Retin-A (for non-cosmetic purposes) |
|
No
| |
| Rogaine or other hair regrowth medications (even if prescribed) |
No
|
No
| |
| Sales tax, shipping and handling fees (for any eligible expense) |
Yes
|
Yes
| |
| Smoking cessation (programs / counseling) |
Yes
|
No
| |
| Smoking cessation drugs (prescription) |
Yes
|
No
| |
| Smoking cessation gum or patches (over-the-counter) |
|
No
| |
| Special equipment |
|
No
| |
| Special foods (gluten-free, salt-free or other for treatment of a medical condition; difference in cost only) |
|
No
| |
| Special school (for mental and physical disabilities) |
|
No
| |
| Speech therapy |
Yes
|
No
| |
| Spermicidals |
|
No
| |
| Sterilization |
Yes
|
No
| |
| Student health fees for dental services (no services actually received; billed for future availability of services) |
No
|
No
| |
| Student health fees for dental services (billed for actual services received) |
Yes
|
Yes
| |
| Student health fees for medical services (no services actually received; billed for future availability of services) |
No
|
No
| |
| Student health fees for medical services (billed for actual services received) |
Yes
|
No
| |
| Student health fees for prescription services (no services actually received; billed for future availability of services) |
No
|
No
| |
| Student health fees for prescriptions (billed for actual services received) |
Yes
|
No
| |
| Student health fees for vision services (no services actually received; billed for future availability of services) |
No
|
No
| |
| Student health fees for vision services (billed for actual services received) |
Yes
|
Yes
| |
| Sunglasses (over-the-counter) |
No
|
No
| |
| Sunglasses (prescription) |
Yes
|
Yes
| |
| Sunscreen with SPF<15 lotion="" or="" over-the-counter="" p="" suntan=""> |
No
|
No
| |
| Sunscreen with SPF 15+ and "broad spectrum", sunburn creams and ointments (over-the-counter) |
Yes
|
No
| |
| Supplies (for treatment of a medical condition) |
Yes
|
No
| |
| Surgery (for non-cosmetic purposes) |
Yes
|
No
| |
| Swimming lessons (for treatment of a medical condition) |
|
No
| |
| Teeth bleaching or whitening |
No
|
No
| |
| Teeth grinding prevention devices |
Yes
|
Yes
| |
| Therapy (for treatment of a medical condition) |
Yes
|
No
| |
| Toothache and teething pain reliever (over-the-counter) |
|
| |
| Toothpaste, medicated (difference in cost only of medicated toothpaste over the standard toothpaste) |
|
No
| |
| Toothpaste, toothbrush, floss, etc. |
No
|
No
| |
| Transgender treatments/surgery |
|
No
| |
| Transportation, parking and related travel expenses (essential to receive eligible care) |
Yes
|
Yes
| |
| Transportation, parking and related travel expenses, for non-eligible expenses |
No
|
No
| |
| Tubal ligation |
Yes
|
No
| |
| Tuition or educational classes |
No
|
No
| |
| Tuition or educational classes (for a specific medical condition |
|
No
| |
| Urological products |
Yes
|
No
| |
| UV protection clothing |
No
|
No
| |
| Vaccinations |
Yes
|
No
| |
| Varicose vein removal surgery (for medical care) |
Yes
|
No
| |
| Vasectomy |
Yes
|
No
| |
| Viagra and similar prescription medications |
Yes
|
No
| |
| Vision co-insurance |
Yes
|
Yes
| |
| Vision co-payment |
Yes
|
Yes
| |
| Vision insurance / plan premiums (paid with after-tax dollars only) |
No
|
No
| |
| Vitamins (over-the-counter, for general health purposes) |
No
|
No
| |
| Vitamins (prescription) |
Yes
|
No
| |
| Walking aids (canes, walkers, crutches and related supplies) |
Yes
|
No
| |
| Warranties or other charges for future anticipated services (with none actually received) |
No
|
No
| |
| Wart removal treatments (over-the-counter) |
|
No
| |
| Weight loss counseling |
|
No
| |
| Weight loss foods |
No
|
No
| |
| Weight loss program (to improve or maintain general health) |
No
|
No
| |
| Weight loss program (for treatment of a medical condition) |
|
No
| |
| Weight loss drugs (for treatment of a medical condition) |
|
No
| |
| Wheelchair and repairs |
Yes
|
No
| |
| Wound care (over-the-counter) |
Yes
|
No
| |
| X-ray fees (dental) |
Yes
|
Yes
| |
| X-ray fees (medical) |
Yes
|
No
|
|
