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Common Eligible & Ineligible Health Care Expenses
Health Care Flexible Spending Account (FSA) and Health Savings Account (HSA)

This list includes services and products that are generally eligible, ineligible or may be eligible for reimbursement from a Health Care FSA or an HSA. Please keep in mind, IRS regulations state you cannot be reimbursed from more than one health care account for the same expense. Some items and services differ between the FSA and the HSA. For those that are different, there is a note next to the item or service. For example, an HSA may reimburse for certain insurance premiums whereas a Health Care FSA cannot.

Limited Purpose Flexible Spending Account (LPFSA) or Health Reimbursement Account (HRA)

For HRA and LPFSA, please review your plan documents. They will tell you if some eligible health care expenses may not be eligible for your plan. For example, a LPFSA may be limited to only dental and vision expenses for the entire plan year. An HRA may cover only certain insurance premiums but not others.

Note: An FSA, LPFSA and HRA have limitations and may have certain exclusions. The information here is general in nature and is for informational purposes only. Please refer to your plan documents for information specific to your plan.

Letter of Medical Necessity (LOMN)

The following eligible expense listing includes a column titled Requires a Letter of Medical Necessity (LOMN). There are certain treatments, services and items that require a LOMN in order for the expense to be considered for reimbursement.

The LOMN can be submitted in one of two ways. 1) Your health care professional can write a note on their letterhead or prescription pad OR 2) You can ask your health care professional to complete a LOMN form. You can print a LOMN form from this website. It is located within the Resource Center under Administrative Forms. The LOMN form or health care professional’s note must include:

  • Date your health care professional completed the LOMN form or wrote their LOMN letter
  • Diagnosis, symptoms or that a medical condition exists for which you, your spouse, or eligible dependent are being treated
  • Specific information on how the product or service is intended to treat the medical condition


Note: Submitting a LOMN with your claim does not guarantee that the expense will be reimbursed. If approved and if the medical condition is ongoing, a new LOMN will be required each year.

Eligible Over-the-counter (OTC) Expenses

For over-the-counter (OTC) medicines or drugs (for ex., acne treatments, allergy and cold medicines, antacids, etc.) you will need a written prescription from your health care provider in order to be reimbursed from a health care account. The only exception is insulin, which will not require a prescription. You do not need a prescription for OTC products or items that are not medicines or drugs, such as bandages and nasal strips.

The prescription must include the information required for any other prescribed medicine. In addition to the written prescription for the OTC medicine, we will need a detailed receipt. A detailed receipt must include the following:

  • Date of service or purchase
  • Name or description of the item
  • Amount of purchase


Note: For an OTC medicine that requires a prescription, you will see an “X” under the column for OTC Medicine/Drug Requires an Rx.

IRS Publication 502 and IRS Publication 969

For more information on eligible expenses, you may refer to IRS Publications 502 and 969. You can find them on our website or at www.irs.gov. Taxpayers use Publication 502 to determine their health care expenses for Schedule A deductions. This means that there are a few differences between it and your employer’s plan. Publication 969 explains what is and is not eligible for a Health Care FSA, HRA and HSA.

Here are some distinctions for FSAs, HRAs and HSAs that are different from what Publication 502 states.

  • Expenses are incurred when you receive the medical care and not when you are formally billed or charged, or pay, for the medical care.
  • Insurance premiums of any type are not eligible expenses under a Health Care FSA.
  • OTC drugs and medicines are eligible expenses only with a written prescription from your health care provider.
  • Certain OTC products and supplies are eligible expenses without a prescription.

Common Eligible and Ineligible Health Care Expenses

The list below includes eligible, potentially eligible and ineligible health care expenses. You can click on a letter in the alphabet to see the items and services that begin with that letter. You can also search for a specific item or service. Press CTRL and F at the same time on your keyboard. Then type the item or service you’re looking for and press “Enter.”

Make sure to see if the item or service has an “X” under any of the following categories:

  • Eligible
  • Requires Letter of Medical Necessity (LOMN)
  • OTC Medicine/Drug Requires an Rx
  • Ineligible


A (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Abdominoplasty (for cosmetic reasons)
  X Generally, the cost of an abdominoplasty is not an eligible medical expense. This procedure may also be known as a Tummy Tuck. The cost of cosmetic surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: adominoplasty, breast augmentations, enhancement, electrolysis (hair/removal), face lift, hair transplant, liposuction, tattoo removal, collagen injections.
Abdominoplasty (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Acne (over-the-counter item)
X The cost of an OTC acne medicine is an eligible medical expense. OTC products include, but are not limited to: Acne Free, Acnomel, Bye Bye Blemish, Clean & Clear, Clearasil, Murad Acne Complex Kit, Neutrogena Acne Treatment, OXY, Pro-active Solution, Stri-Dex, SAPZYT Acne Treatment.
Acne (routine skin care)
  X Cost of routine skin care is not an eligible medical expense.
Acne (services)
X If the primary purpose is treatment of acne, acne services are eligible medical expenses.
Acupressure
  X A health care professional must provide evidence of medical necessity for the cost of acupressure to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursesment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical conditiont.
Acupuncture
X The cost of acupuncture is an eligible medical expense.
Adaptive Equipment
X The cost to purchase or rent adaptive/durable medical equipment is an eligible medical expense. This includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet.
Adoption Medical Expenses (for tax qualified dependents)
X If the child is a tax-qualified dependent at the time of service, medical expenses paid for a child prior to adoption are eligible medical expenses. 
Adoption Medical Expenses (incurred before adoption negotiations)
  X Fees relating to the adoption process and fees for medical expenses incurred prior to beginning adoption negotiations are not eligible medical expenses.
Adoption Medical Expenses (incurred by birth mother, associated with birth)
  X Expenses incurred by the birth mother associated with an adopted baby’s birth are not eligible medical expenses.
Air Conditioner, Air Filter, Air Purifier
  X A health care professional must provide evidence of medical necessity for the cost of a portable or permanent unit to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the Air Conditioner, Air Filter, Air Purifier is a permanent improvement that increases the value of the property, the excess value is not reimbursable. Also see Publication 502 at www.irs.gov for more information, including a worksheet.
Air Fare (primarily for medical care)
X The cost of air fare primarily for and essential to medical care, is an eligible medical expense. Air fare is an eligible medical expense if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons.
Alcoholism, Drug Addiction Treatment
X The cost of treatment at a center for alcohol or drug addiction is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment.
Allergy Medicine
X The cost of an OTC allergy medicine is an eligible medical expense. OTC products include, but are not limited to: Benadryl, Claritin, Dimetapp, Zyrtec.
Allergy Products (used even without allergies)
  X If the product would be owned even without allergies (such as a pillow or vacuum cleaner), the expense is generally not an eligible expense.
Allergy Treatment Products (required for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of allergy treatment products to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical conditiont. Note: The reimbursable expense includes only the amount above the cost of the product in its standard form.
Alopecia Treatment
  X Alopecia is a medical condition resulting in the loss of hair from the body or head that can lead to baldness. A health care professional must provide evidence of medical necessity for the cost of alopecia treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement that specifically identifies that the recommendation and expense is for treatment of the medical condition.
Alternative Healers
X Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition.
Alternative Medicine, Alternative Healers (for general health)
  X Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses.
Alternative Medicine, Alternative Healers (for medical condition)
  X Treatments provided by non-traditional alternative healer professionals are eligible if treating a specific medical condition. A health care professional must provide evidence of medical necessity for the cost of alternative medicine to be an eligible medical expense. Include evidence of medical necessity (i.e., a doctor's note or LOMN that specifically identifies that the recommendation and expense is for treatment of the medical condition) with the request for reimbursement. Drugs, medicines and treatments provided by non-traditional alternative healer professionals are eligible if a diagnosis is available indicating it is for a medical condition.
Ambulance Service
X The fee paid for ambulance service is an eligible medical expense. 
Analgesics (painkillers), Antipyretics (fever reducers)
X The cost of an OTC analgesic is an eligible medical expense. OTC products include, but are not limited to: Advil, Aspirin, Midol, Naprosyn, Pamprin, Premsyn PMS, Tylenol, Aspercreme, BenGay, Icy Hot.
Anesthesiology
X Anesthesiology fees are eligible medical expenses
Antacids, Acid Reducers
X The cost of an OTC antacid is an eligible medical expense. OTC products include, but are not limited to: Alka-Seltzer, Brioschi, Maalox, Milk of Magnesia, Mylanta, Pepto-Bismol, Prilosec.
Antibiotics, topical
X The cost of an OTC antibiotic is an eligible medical expense. OTC products include, but are not limited to: Cortaid, Neosporin, Polysporin.
Anti-Diarrhea
X The cost of an OTC anti-diarrhea product is an eligible medical expense. OTC products include, but are not limited to: Pepto Bismol, Imodium AD, Kaopectate.
Anti-Embolism Socks, Stockings
X The cost of compression socks, also known as anti-embolism socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense.
Anti-Fungal
X The cost of an OTC anti-fungal product is an eligible medical expense. OTC products include, but are not limited to: Lamisil AT, Lotrimin AF, Micatin.
Anti-Gas
X The cost of an OTC anti-gas product is an eligible medical expense. OTC products include, but are not limited to: Mylanta, Gelusil, Phazyme, Gas-X.
Antihistamines
X The cost of an OTC antihistamine is an eligible medical expense. OTC products include, but are not limited to: Benadryl, Claritin, Contac, Dimetapp, Sudafed, Triaminic.
Anti-Itch
X The cost of an OTC anti-itch product is an eligible medical expense. OTC products include, but are not limited to: Aveeno/Gold Bond Anti-Itch, Benadryl, Cortaid, Calamine lotion, Cortizone, Lanacane.
Appearance Improvement
  X Appearance improvement for cosmetic reasons is not an eligible medical expense. The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense because it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Arch and Insole Support
X The cost of custom made and over the counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense.
Arthritis Care
X The cost of an OTC arthritis medicine is an eligible medical expense. OTC products include, but are not limited to: Arthritis gloves, Arthritis Hot, Bengay, Capzasin.
Artificial Eye, Limb, Teeth
X Amount paid for the design and purchase of an artificial limb, eye or teeth is an eligible medical expense.
Artificial Insemination (active attempt to conceive)
  X When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Artificial Reproductive Technologies (active attempt to conceive)
  X When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as the member, spouse or a qualified dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Aspirin
X The cost of an OTC aspirin is an eligible medical expense.
Assisted Living Facility
  X Living expenses in an assisted living facility for permanent residence are not eligible medical expenses.
Asthma Equipment and Treatment
X The cost of asthma equipment (e.g., a nebulizer or peak flow meter) is an eligible medical expense. 
Asthma Equipment and Treatment (over-the-counter products)
X The cost of an OTC asthma product is an eligible medical expense. OTC products include, but are not limited to: Bronkaid, Bronkolixir, Primatine.
Autoette (wheelchair)
X The cost of an autoette is an eligible medical expense.
Automated External Defibrillator (AED)
X The cost of an automated external defibrillator is an eligible medical expense.
Automobile Modifications (cost of operating the car)
  X The cost of operating a specially equipped car is not an eligible medical expense.
Automobile Modifications (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of car modifications such as hand controls and other special equipment installed in a car including installation costs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car.
Automobile Modifications (specially designed car to hold a wheelchair)
X The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car.
Autopsy
  X Fees associated with an autopsy are not eligible medical expenses.

B (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Baby Formula
  X For the cost of baby formula to be an eligible medical expense, a health care professional must provide evidence of medical necessity showing that the qualified employee’s infant requires special dietary requirements, and a specific baby formula is recommended to treat the illness or disorder. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is calculated using a cost difference method of subtracting the amount paid for standard baby formula from the cost of the special formula.
Baby Health Monitor
X The cost of a baby monitor that monitors and tracks a baby’s heart rate and/or breathing while they sleep, is an eligible medical expense. Examples include but are not limited to: Owlet, Miku, Nanit
Babysitting, Child and Dependent Care (for healthy child)
  X The cost of babysitting, child care and nursing services for a healthy child or dependent are not eligible medical expenses.
Back Brace
X Both Rigid (Hard) and Soft (Elastic) Back Braces are eligible medical expenses.
Baldness Treatment (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Baldness Treatment (for medical condition)
  X A health care professional must provide evidence of medical necessity such as the result of chemotherapy treatment, disease, trauma or injury for the cost of treatment, for baldness to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Bandages, Band-Aids
X The cost of bandages is an eligible medical expense. Bandages include, but are not limited to: Ace bandages, Band-Aid, Curad, Johnson & Johnson, Nexcare.
Bariatric Surgery
  X A health care professional must provide evidence of medical necessity for the cost of bariatric surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Bariatric Surgery (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Bariatric Surgery (for obesity treatment)
X The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of these surgeries.
Bedside Commode, Toilet (for medical reasons)
X The cost to purchase or rent a bedside commode or bedside toilet is an eligible medical expense.
Behavioral Modification Programs
  X A health care professional must provide evidence of medical necessity for the cost of special and residential schools/programs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. If the main reason for using a program, is its resources to work with children who have learning disabilities due to a mental or physical impairment — payments for a special program are eligible medical expenses. Note: The cost of meals, lodging and ordinary education by the special school/program may also be eligible expenses, if the main reason for the child being there is for the school’s resources to relieve the mental or physical disability. Eligible reasons can include but are not limited to: teaching braille to a visually-impaired child, teaching sign language or lip reading to a hearing-impaired child and remedial language training to correct a condition caused by a birth defect.
Bio-identical Hormone Replacement Therapy (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of Bio-identical Hormone Replacement Therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursment. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Bio-identical Hormone Replacement Therapy (used as an enhancement)
  X Hormone replacements used as an enhancement for body-builders, athletes and others are not eligible medical expenses.
Birth Control (over-the-counter)
X The cost of an OTC birth control product is an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides.
Birth Control (prescription)
X The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense.
Birthing Classes (not related to the actual childbirth)
  X The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breastfeeding vs. bottle feeding, newborn care) is not an eligible medical expense. 
Birthing Classes (related to childbirth)
X Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for that portion.
Birthing Coach
  X A health care professional must provide evidence of medical necessity for the cost of a birthing coach who provides medical care for the mother or child to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Bleaching or Whitening Teeth
  X The cost of bleaching or whitening teeth is not an eligible medical expense.
Blepharoplasty (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Blepharoplasty (for medical condition)
  X A health care professional must provide evidence of medical necessity for Blepharoplasty to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Blood Donor Fee
  X A health care professional must provide evidence of medical necessity for the cost of blood donation to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: A fee associated with blood donation is an eligible medical expense when the blood is for use by the participant, spouse or eligible dependent. 
Blood Pressure Monitor
X The cost of a blood pressure monitoring device is an eligible medical expense.
Blood Storage
  X A health care professional must provide evidence of medical necessity for the cost of blood storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to store blood would be an eligible medical expense.
Blood Sugar Test Kits and Strips
X Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs.
Body Restoration Technique
  X A health care professional must provide evidence of medical necessity for the cost of body restoration to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Body Scan
X The cost of a body scan (e.g., an MRI, PET, CAT) is an eligible medical expense.
Botox Injections (for cosmetic reasons)
  X Amounts paid for cosmetic services, such as Botox injections to eliminate wrinkles, are not eligible medical expenses.
Botox Injections (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of Botox injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note of LOMN must specifically identify the recommendation and expense is for treatment of the medical condition (i.e. treatment of migraines).
Boutique, Concierge, Practice Fees
  X The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care is needed.
Bracanalysis Testing
X The cost of diagnostic testing for genetic mutations that may include DNA collection is an eligible medical expense.
Braces, Orthodontia
X The cost of orthodontia care (including braces and invisalign) is an eligible medical expense.
Braille Books and Magazines
X For use by visually impaired persons, the cost of Braille books and magazines are eligible medical expense. Note: The eligible expense includes only the amount above the cost of the product in its standard form.
Breast Augmentation (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Breast Implants or Removal (for cosmetic reasons)
  X The cost to replace a cosmetic implant (i.e. reduction or enlargement) is not an eligible medical expense.
Breast Implants or Removal (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of breast implants or removal to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Breast Pump Purchase or Rental
X The cost to purchase or rent a breast pump is an eligible medical expense.
Breast Reconstruction Surgery
X The cost of breast reconstruction surgery following a mastectomy is an eligible medical expense.
Breast Reduction (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Breast Reduction (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of breast reduction surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Breastfeeding Supplies
X Breastfeeding supplies are the equipment and disposable supplies that assist with breastfeeding or nursing. The cost of those supplies are eligible medical expenses. This includes but is not limited to: breast pumps, disposable bra pads, lanolin cream, breastfeeding tubes and containers.
Breathalyzer
X The cost of both in-home and doctor's office alcohol testing are eligible expenses.
Bus Fare (primarily for medical care)
X The cost of bus fare primarily for and essential to medical care, is an eligible medical expense. Bus fare expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons.

C (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Calcium (for general health)
  X When calcium is taken for general good health (even when recommended by a health care professional), the amounts paid for calcium are not eligible medical expenses.
Calcium (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of calcium to be an eligible medical expense. Include a doctor's note or Letter of Medical (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Capital Expense (cost of installing equipment in home)
  X A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as a ramp or wheelchair lift) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov.
Car Modification (cost of operating the car)
  X The cost of operating a specially equipped car is not an eligible medical expense.
Car Modification (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of car modifications such as hand controls and other special equipment installed in a car including installation costs to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Car Modification (specially designed car to hold a wheelchair)
X The expense of a specially designed car to hold a wheelchair may be reimbursed only to the extent the cost of the special car exceeds the cost of a regular car.
Car Rental (primarily for medical care)
X The cost of a car rental primarily for and essential to medical care, is an eligible medical expense. Car rental expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Note: Long-distance travel cannot be for purely personal reasons.
Carpal Tunnel Wrist Supports, Braces
X The cost of carpal tunnel wrist supports is an eligible medical expense
Cervical Pillow
  X A health care professional must provide evidence of medical necessity for the cost of pillows for lumbar and cervical support to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Chairs, Reclining
  X A health care professional must provide evidence of medical necessity for the cost of a reclining chair to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is calculated using a cost difference method of subtracting the amount paid for a standard chair from the cost of a specialized chair.
Chelation Therapy
  X A health care professional must provide evidence of medical necessity such as lead poisoning for the cost of chelation therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Chemical Peel (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Childbirth
X Amounts paid to a physician or licensed midwife for child delivery are eligible medical expenses.
Childbirth Classes/Lamaze (not related to the actual childbirth)
  X The portion of instruction not related to childbirth (such as possible discomfort and mood swings, learning about your unborn baby’s growth and development, breastfeeding vs. bottle feeding, newborn care) is not an eligible medical expense. 
Childbirth Classes/Lamaze (related to childbirth)
X Class time instruction related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movie depicting vaginal and cesarean delivery and cesarean discussion) is an eligible medical expense. Note: Documentation must clearly show the portion of the Lamaze classes dedicated to childbirth. Reimbursement will be just for that portion.
Chinese Herbal Practioner and Herbal Treatments (for general health)
  X Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses.
Chinese Herbal Practitioner
X Treatments provided by a Chinese Herbal Practitioner are eligible if treating a specific medical condition.
Chiropody
X Amounts paid to a chiropodist (a chiropractic foot doctor) is an eligible medical expense.
Chiropractor
X The cost of chiropractor services is an eligible medical expense.
Cholesterol Testing
X OTC portable blood test systems (such as Cardio Chek) and test strips are an eligible medical expense.
Christian Science Practitioners
X Treatments provided by a Christian Science Practitioners are eligible if treating a specific medical condition.
Christian Science Treatments (for general health)
  X Alternative treatments, healers, drugs and medicines for general health, are not eligible expenses.
Circumcision
X The cost of circumcision is an eligible medical expense.
Clinic
X The cost of medical treatment at a health clinic is an eligible medical expense. 
Club Dues and Fees (for general health/non-medical)
  X Health club dues paid for general health or to relieve physical or mental discomfort not related to a medical condition are not eligible medical expenses.
Club Dues and Fees (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of dues paid to a health club or gym to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is only for the individual membership and for the component that is related to the current plan year. Any dues that carry over to another plan year must be submitted for that plan year of coverage. Even if you're required to prepay for an entire year, membership fees may only be reimbursed each month.
COBRA Premiums (if you have a health care FSA)
  X Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses.
COBRA Premiums (If you have an HSA)
X Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage; health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. However, insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap.
Co-Insurance
X A coinsurance charge for medical care is an eligible medical expense. 
Cold and Hot Packs (for medical purposes)
X When used for medical purposes, amounts paid for cold and hot packs are eligible medical expenses.
Cold and Hot Packs (for non-medical use)
  X When used for other purposes (e.g., to keep beverages hot or cold), amounts paid for cold and hot packs are not eligible medical expenses.
Cold Medicines
X The cost of an OTC cold medicine is an eligible medical expense. OTC products include, but are not limited to: Advil, Comtrex, Contac, Coricidin, Dayquil, Mucinex, Nyquil, Robitussin, Sudafed, TheraFlu, Triaminic, Vicks.
Cold Sore and Fever Blister Treatments (lip balm SPF 15 or higher)
X The cost of medicated lip balm with an SPF 15 or higher is an eligible medical expense.
Cold Sore and Fever Blister Treatments (lip balm SPF lower than 15)
  X The cost of medicated lip balm with no SPF or an SPF lower than 15 is not an eligible medical expense.
Cold Sore and Fever Blister Treatments (over-the-counter)
X The cost of an OTC cold sore or fever blister product is an eligible medical expense. OTC products include, but are not limited to: Abreva Cream, Herpecin.
Collagen Injections (for cosmetic reasons)
  X The cost of collagen injections for cosmetic purposes is not an eligible medical expense.
Collagen Injections (for medical condition)
  X A health care professional must provide evidence of medical necessity such as urinary incontinence or severe acne for the cost of collagen injections to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Colon Therapy, Colon Hydrotherapy, Colonics
  X A health care professional must provide evidence of medical necessity for the cost of colon therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Companion Animal
X The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense. Note: Amounts paid for the care of a specially trained animal are also eligible medical expenses.
Compression Socks, Stockings
X The cost of compression socks, also known as anti-embolism socks and stockings which assist with circulation in the feet and legs for people with diabetes, amputations, burns, deep vein thrombosis is an eligible medical expense.
Concierge Medicine
  X The cost of monthly or annual fees (retention fee) to guarantee that the physician is available when needed is not an eligible medical expense. This is because the fee is paid regardless if medical care is needed.
Condoms
X The cost of condoms are an eligible medical expense.
Contact Lens Service Agreement and Warranty
  X Any fees for vision discount programs or warranties are not eligible medical expenses.
Contact Lenses and Supplies (for cosmetic reasons)
  X Amounts paid for cosmetic contact lenses (such as to change eye color without vision correction) are not eligible medical expenses.
Contact Lenses and Supplies (for vision correction)
X If contact lenses are needed to correct vision, amounts paid for the purchase of contact lenses (including shipping and handling fees) are eligible medical expenses. Amounts paid for contact lens solution, cleaning or soaking solutions, lens storage cases, supplies and exams (including fittings) are also eligible expenses.
Contact Lenses and Supplies (over-the-counter products)
X The cost of an OTC eye drop and re-wetting product is an eligible medical expense. OTC products include, but are not limited to: Visine, Opcon-A, Clear eyes.
Continuous Positive Airway Pressure (CPAP)
X The cost of the breathing therapy known as CPAP is an eligible medical expense.
Contraceptives
X The cost of prescription birth control (such as IUD, diaphragm, pill, Norplant, etc.) is an eligible medical expense. The cost of an OTC birth control product is also an eligible medical expense. OTC products include, but are not limited to: condoms, Morning-After Pill or OTC emergency contraceptive which can help prevent a pregnancy after unprotected sex or contraceptive failure, spermicides.
Controlled Substances
  X The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible.
Convalescent Home (custodial care)
  X The cost of custodial care in a convalescent or nursing home (e.g., long term care) is not an eligible medical expense.
Convalescent Home (medical care, meals & lodging)
  X A health care professional must provide evidence of medical necessity for the cost of medical care provided during a temporary stay in a convalescent, nursing home or skilled facility, (e.g., following a hospital stay or surgery) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. This includes the cost of meals and lodging in the convalescent/nursing home if the main reason for being there is to receive medical care in order to return home. If participant resides permanently in the facility, only separately stated medical expenses would be eligible for reimbursement (e.g. individually billed doctor visits; prescription costs).
Copayment (copay)
X A medical copayment is an eligible medical expense. Note: The receipt must clearly state that the expense is a copayment for a healthcare service.
Cord Blood (harvesting/storage for medical condition)
  X A health care professional must provide evidence of medical necessity with the infant or other family member covered under the health care account, for the cost of harvesting and storing cord blood to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to collect, freeze and store umbilical cord blood would be an eligible medical expense.
Cord Blood (harvesting/storage for non-medical reasons)
  X Storage and harvesting fees paid for non-medical reasons or to preserve the cord blood for future use are not eligible medical expenses. 
Corneal Molding
X Cost for orthokeratology (also known as corneal molding) is an eligible medical expense. It is a surgical procedure similar to Lasik Surgery to improve or correct near sightedness, far sightedness and astigmatism.
Corneal Ring Segments
X The cost of these devices implanted in the eye to correct vision is an eligible medical expense.
Cosmetic Treatment (for medical condition)
  X A health care professional must provide evidence of medical necessity such as improve a deformity arising from, or directly related to, a congenital abnormality, personal injury or disfiguring disease, for the cost of cosmetic surgery to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Cosmetic Treatment (for non-medical reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Cough Suppressants
X The cost of an OTC cough suppressant is an eligible medical expense. OTC products include, but are not limited to: cough syrup and cough drops.
Counseling (for medical condition)
X The cost of counseling for a medical condition is an eligible medical expense.
Counseling (marriage/family for non-medical reasons)
  X Fees paid for marriage counseling, family counseling and support counseling for other family members to learn how to cope with a family member’s illness are not eligible medical expenses.
COVID-19 Home Test
X The cost of home testing for COVID-19 is an eligible medical expense.
CPR
  X The cost of a CPR class is not an eligible medical expense.
Crania-Sacral Therapy
  X A health care professional must provide evidence of medical necessity for the cost crania-sacral therapy to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Crown, dental
X The cost of a crown is an eligible medical expense.
Crutches
X The purchase or rental of crutches is an eligible medical expense.
Crystalens
X Artificial lens implants used to treat cataracts is an eligible medical expense. The cost of the FDA approved procedure where the patient’s lens is removed and replaced with a clear plastic lens that allows him or her to focus more accurately is also an eligible medical expense.

D (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Dance Lessons (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of fees paid for lessons to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Dance Lessons (non-medical)
  X Fees paid for lessons not recommended by a health care professional or not specific to a medical condition are not eligible medical expenses
Decongestant
X The cost of an OTC decongestant is an eligible medical expense. OTC products include, but are not limited to: Contac-D, Dimetapp, Sudafed, Triaminic.
Deductibles
X Deductibles are eligible medical expenses.
Defibrillator
X The cost of a defibrillator is an eligible medical expense.
Dehumidifier
  X The cost of a dehumidifier is not an eligible medical expense.
Dehydration Treatment
X The cost of an OTC dehydration product is an eligible medical expense. OTC products include, but are not limited to: Pedialyte.
Dental Emergency Kit
X A dental emergency kit used for the temporary repair of loose caps or lost fillings is an eligible medical expense.
Dental Maintenance Organization (DMO) Fees (if you have a health care FSA)
  X Premiums paid for dental, health and long-term care insurance benefits, including COBRA premiums, fees to belong to a HMO and premiums paid as part of a Section 125 payroll reduction plan, are not eligible health care FSA expenses.
Dental Maintenance Organization (DMO) Fees (if you have an HSA)
X Insurance premiums are eligible HSA expenses in only the following situations: COBRA continuation of health care coverage (including dental coverage); health care coverage while receiving unemployment compensation; long-term care (LTC) coverage only up to the annual amount allowed by age; and for those age 65 or older, insurance premiums for health care coverage including Medicare Parts A, B and D. Insurance premiums are not eligible medical expenses for an HSA for those age 65 or older, if the premiums are for Medicare supplement policies, such as Medigap.
Dental Treatment (non-cosmetic)
X Amounts paid for dental treatment (X-rays, fillings, extractions, dentures (artificial teeth), caps, crowns, fluoride treatments, implants, non-cosmetic veneers etc.) and orthodontia (including braces and Invisalign) are eligible medical expenses.
Dental Treatment (oral hygiene & supplies)
  X Ineligible items include, but are not limited to: toothpaste, toothbrushes (including a specialized or battery-powered toothbrush), oral hygiene products such as oral rinses, veneers for cosmetic purposes and cost of cosmetic dental treatments.
Dental Treatment (over-the-counter flouride)
X The cost of an OTC fluoride product is an eligible medical expense.
Dental Treatment (tooth bonding)
  X A health care professional must provide evidence of medical necessity for tooth bonding to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Dental, cosmetic
  X The cost of cosmetic dental treatment is not an eligible medical expense.
Denture Adhesive
X The cost for a product to secure dentures in the mouth is an eligible medical expense. Examples include, but are not limited to: Fixodent, Polident, Effergrip and Sea-Bond.
Denture Cleanser
X The cost for a product to clean dentures is an eligible medical expense.
Dentures (for cosmetic reasons)
  X Cosmetic dentures are not an eligible medical expense.
Dentures (non-cosmetic)
X Non-cosmetic dentures are an eligible medical expense.
Denturist
X Amounts paid to a denturist for the treatment of a dental condition are eligible medical expenses. (A denturist is a dental technician specializing in making and fitting dentures as a direct service to the public rather than through a licensed dentist.) 
Dependent Care (for disabled person)
  X A health care professional must provide evidence of medical necessity for the cost of care for a disabled dependent to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Dependent Care (for healthy child)
  X The cost of babysitting, child care and nursing services for a healthy child or dependent are not eligible medical expenses.
Dermabrasion (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Dermatology (for cosmetic reasons)
  X Amounts paid to a dermatologist for cosmetic services (such as botox injections to eliminate wrinkles) are not eligible medical expenses.
Dermatology (for medical condition)
X Amounts paid to a dermatologist for a medical condition (such as acne or psoriasis) are eligible medical expenses.
Diabetic Equipment and Supplies
X Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs.
Diagnostic Tests and Procedures
X Amounts paid for diagnostic services are eligible medical expenses.
Diaper Rash Creams
X The cost of an OTC diaper rash product is an eligible medical expense. OTC products include, but are not limited to: Aquaphor, Balmex, Desitin.
Diapers, Diaper Service
  X A health care professional must provide evidence of medical necessity for the cost of diapers and diaper service to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. However, the cost of an incontinence product is an eligible medical expense. Examples include, but are not limited to: Depend, Invacare, Poise, Prevail, Serenity.
Diarrhea Medicine
X The cost of an OTC anti-diarrhea product is an eligible medical expense. OTC products include, but are not limited to: Pepto Bismol, Imodium AD, Kaopectate.
Diathermy
X The cost of diathermy used to destroy abnormal cells or as a form of physical therapy is an eligible medical expense.
Diet Food
  X The cost of food, including diet food or meal replacements such as shakes for weight loss programs, is not an eligible medical expense to the extent it is for ordinary nutritional value. Therefore the cost of food associated with weight-loss programs, such as pre-packed meals and diet food, is not eligible since the food is a substitute for regular food and meets normal nutritional needs.
Dietary Supplement (for general health)
  X When dietary supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for supplements, herbs, minerals, and vitamins are not eligible medical expenses.
Dietary Supplement (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Dietician
  X A health care professional must provide evidence of medical necessity for the cost of dietician to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Digestive Aids (for general health)
  X When digestive aids are taken for general good health (even when recommended by a health care professional), the amounts paid for digestive aids are not eligible medical expenses.
Digestive Aids (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of digestive aids to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Digestive Aids (over-the-counter)
X The cost of over-the-counter digestive aids is an eligible medical expense. This includes but is not limited to: acid controllers, laxatives, anti-diarrheals, and anti-gas medicine.
Disabled Dependent Care
  X A health care professional must provide evidence of medical necessity for the cost of care for a disabled dependent to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
DNA Collection and Storage (for paternity testing)
  X The cost of a DNA test to determine paternity is not an eligible medical expense
DNA Testing Kits (ancestry portion)
  X The cost of the ancestry portion is not an eligible expense.

Note: If the documentation states Health + Ancestry, a breakdown of the cost for each will be required. Only the health (or medical care) portion is eligible.
DNA Testing Kits (health or medical portion)
X The cost of the testing kit’s health or medical care portion is an eligible medical expense.

Examples include but are not limited to: 23andMe, Ancestry, EverlyWell and MyHertiage
Doctor Fees
X The cost of doctor fees are an eligible medical expense.
Doula Fees
  X A health care professional must provide evidence of medical necessity for the cost of a doula who provides medical care for the mother or child to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Drug Addiction Treatment
X The cost of treatment at a center for alcohol or drug addiction is an eligible medical expense. This includes meals and lodging provided by an inpatient center during treatment.
Drug Overdose Treatment
X The cost of treatment for a drug overdose is an eligible medical expense.
Drugs (controlled substances)
  X The cost of a substance that violates federal law, even when it is allowed by state law and used to treat a diagnosed medical condition, is not an eligible medical expense. This includes but is not limited to: marijuana, CBD oil, cartridges, edibles, vapes, hemp extract. Note: If the above are submitted with a Letter of Medical Necessity (LOMN), the expense is still ineligible.
Drugs (over-the-counter)
X The cost of an OTC product, drug or medicine is an eligible medical expense.
Drugs (prescription)
X The cost of a prescription drug is an eligible medical expense. (A prescribed drug is one that requires an order from a medical professional and is dispensed through a pharmacy for use by an individual.) Note: Eligible expenses also include delivery charges and mail-order postage and handling fees.
Durable Medical Equipment (DME)
X The cost to purchase or rent durable medical equipment is an eligible medical expense. DME includes but is not limited to: bed wetting alarm, blood pressure kit, crutches, hearing aid, hospital bed, medical alert equipment and adaptive equipment that assists in activities of daily living such as bath chairs, wheelchairs, bedside commode and bedside toilet.
Dyslexia Treatment
  X A health care professional must provide evidence of medical necessity for dyslexia treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.

E (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Ear Care and Ear Wax Removal Products
X The cost of an OTC ear care product is an eligible medical expense. OTC products include, but are not limited to: Debrox, Murine.
Ear Plugs
  X A health care professional must provide evidence of medical necessity for the cost of ear plugs to be an eligible medical expense. Include evidence of medical necessity (i.e., a doctor's note or LOMN that specifically identifies that the recommendation and expense is for treatment of the medical condition) with the request for reimbursement.
Ear, Body Piercing
  X The cost of ear or body piercing is not an eligible medical expense.
Educational Classes (for medical condition)
  X The cost of an educational class specific to a medical condition such as learning to manage diabetes or learning Braille is a qualified medical expense. Submit evidence of the medical condition as well as the class description with the request for reimbursement.
Educational Classes (non-medical/general well-being)
  X The cost of an educational class not specific to a medical condition or for general well-being (such as care for newborn) is not an eligible medical expense. 
Egg and Embryo Storage Fees
  X A health care professional must provide evidence of medical necessity for the cost of eggs and embryo storage to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: As long as a medical condition is present, the cost to store eggs and embryos would be an eligible expense.
Egg and Sperm Donor Fees
  X When associated with an active attempt to conceive, amounts paid for egg and sperm donation are eligible medical expenses. A health care professional must provide evidence of medical necessity for the cost of egg and sperm donor fees to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: The donor fee, agency fee, donor's medical and psychological testing, as well as legal contract fees are eligible if medically necessary for the procedure to be performed on you, your spouse or eligible dependent.
Egg Recipient Fees
  X A health care professional must provide evidence of medical necessity for the egg recipient fees (legal, recipient testing and agency fees) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify how a patient's reproductive problems related to their medical condition results in the need for receiving eggs. Note: The egg recipient fees are eligible if medically necessary for the procedure to be performed on you, your spouse or eligible dependent.
Electrolysis (hair removal for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Electrolysis (hair removal for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of hair removal or a hair transplant to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Electronic Cigarettes
  X The cost of an electronic cigarette is not an eligible medical expense. It is not an approved smoking cessation product but rather a replacement.
Elevator
  X A health care professional must provide evidence of medical necessity for the cost of installing equipment in the home (such as an elevator) to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: If the capital expense is a permanent improvement that increases the value of the property, the excess value is not reimbursable. For more information, see IRS Publication 502 at www.irs.gov.
Epsom Salts
X Eligible when used as a Soaking Aid for sprains and bruises.
Erectile Dysfunction Treatment
X The cost for the treatment of erectile dysfunction is an eligible medical expense. This includes but not limited to prescribed medications: Viagra, Cialis, Levitra.
Excess Skin Removal
  X A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Exercise Equipment, Exercise Program (for general health)
  X The cost of exercise equipment or an exercise program for improvement of general health is not an eligible medical expense
Exercise Equipment, Exercise Program (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of exercise equipment/wearable technology, including a Fitbit, or an exercise program, including Wii games to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the type/name of the equipment or program is for treatment of the medical condition. If you can provide an itemized receipt separating the cost of the additional feature(s), only the amount of those additional features would be eligible for reimbursement. If you cannot provide an itemized statement showing the cost of the additional feature(s), the full cost of the product is not eligible for reimbursement. Products include but not limited to: Tom Tom, iWatch, Moto 360, Smart Watches, Android, LG, Tag Heuer. Note: The cost of a computer or Wii console would not eligible for reimbursement as they are dual purpose.
Expectorant
X The cost of an OTC expectorant is an eligible medical expense. OTC products include, but are not limited to: Broncolin, Mucinex, TheraFlu, Tussin EX.
Expenses not incurred during the coverage period
  X Expenses not incurred during the coverage period or before the HSA account is opened are not eligible medical expenses.
Expenses that have been reimbursed previously under or could be reimbursed under another medical plan
  X Expenses that have been reimbursed previously under or could be reimbursed under another medical plan are not eligible medical expenses.
Experimental Drugs
X The cost of prescription and legally-obtained experimental drugs for medical care is an eligible medical expense
Experimental Medical Services
X When administered by a health care professional to treat a medical condition, the cost of experimental medical services are an eligible medical expense.
Eye Care (for eye drops)
X The cost of an OTC eye drop is an eligible medical expense. OTC products include, but are not limited to: Visine, Wetting drops.
Eye Care, Eyeglasses (warranties)
  X The cost of warranties for eyeglass repairs and replacements is not an eligible medical expense.
Eye Exams, Eyeglasses, Eye Surgery, Eye Care
X The cost of prescription eyeglasses, prescription sunglasses, eye exams, eye patches, reading glasses, OTC reading glasses, tinting of prescription eyewear, prescription goggles and prescription safety glasses are eligible medical expenses. This also includes but not limited to: cataract surgery, Lasik surgery, Corneal Rings.
Eye Exams, Eyeglasses, Eye Surgery, Eye Care (for repairs)
X Repairs associated with the repair of Eyeglasses, Prescription Sunglasses, Reading Glasses and Prescription Goggles/Safety Glasses are eligible medical expenses.
Eye Exams, Eyeglasses, Eye Surgery, Eye Care (not needed for vision correction)
  X Amounts paid for over-the-counter sunglasses, as well as eyeglasses not needed for vision correction or reading, are not eligible medical expenses.

F (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Face Lift
  See Cosmetic Treatment.
Face Lift (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Feminine Hygiene Products
X The cost of feminine hygiene products are eligible medical expenses. This includes, but is not limited to: sanitary napkins, pads, liners, tampons, cups, sponges.
Fertility Enhancement and Treatments
  X When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as you, your spouse or a eligible dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Fertility Enhancement and Treatments (fees for preserving)
  X Fees paid for preserving semen or embryos for future generations (including for genetic information) are not eligible medical expenses.
Fertility Enhancement and Treatments (ovulation kit)
X The cost of an ovulation kit is an eligible medical expense.
Fertility Enhancement and Treatments (surrogate or gestational carrier expenses)
  X Surrogate or gestational carrier expenses are generally not eligible expenses for the participant.
Fever Reducing Medication
X The cost of an OTC fever reducing medicine is an eligible medical expense. OTC products include, but are not limited to: Aspirin, FeverAll, Ibuprofen, Motrin, Tylenol.
Fiber Supplement (for general health)
  X When fiber supplements are taken for general good health (even when recommended by a health care professional), the amounts paid for fiber supplements are not eligible medical expenses.
Fiber Supplement (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of supplements, herbs, minerals and vitamins to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Finance Charges
  X Fees that are finance charges for unpaid medical expenses are not eligible medical expenses.
First Aid Drugs and Medicines
X The cost of an OTC first aid medicines is an eligible medical expense. OTC products include, but are not limited to: Anti-Bacterial Sprays, Antiseptics, Peroxide, Rubbing Alcohol, Witch Hazel.
First Aid Kit
X The cost of a first aid kit is an eligible medical expense.
First Aid Supplies
X The cost of first aid supplies is an eligible medical expense. First aid supplies include, but are not limited to: bandages, wraps, adhesives, cold or hot packs, gauze, joint supporters, splints, tape, thermometer.
Fitness Program (for general health)
  X The cost of a fitness program for improvement of general health is not an eligible medical expense.
Fitness Program (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of a fitness program to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the program is for treatment of the medical condition.
Flavoring Added to Medication
X The cost of adding flavoring to medication is an eligible medical expense.
Flu Shot
X The cost of a flu shot is an eligible medical expense.
Fluoride Device and Treatment (In home or Office)
  X A health care professional must provide evidence of medical necessity for the cost of home water fluoride treatment, including installation and rental charges to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Fluoride product (over-the-counter)
X The cost of an OTC fluoride product is an eligible medical expense.
Fluoride Rinse, Pills and Toothpaste
  X Fluoride rinse, pills and toothpaste are not eligible medical expenses.
Food
  X The cost of food, including diet food or meal replacements such as shakes for weight loss programs, is not an eligible medical expense to the extent it is for ordinary nutritional value. Therefore the cost of food associated with weight-loss programs, such as pre-packed meals and diet food, is not eligible since the food is a substitute for regular food and meets normal nutritional needs.
Foot Care (non-medicated)
X The cost of non-medicated foot care products is an eligible medical expense. Non-medicated foot care include, but are not limited to: callous removers, bunion treatments, non-medicated blister care products. The cost of custom made and over the counter inserts, orthotics or supports that are designed to treat an injured or weakened body part is an eligible medical expense.
Foot Care (over-the-counter)
X The cost of an OTC foot care product is an eligible medical expense. OTC products include, but are not limited to: medicated blister care, medicated callous removers, corn & callous treatments.
Forms Completion
  X Charges incurred for provider completion of forms is not an eligible medical expense. Including, but not limited to the following examples: disability form, FMLA form, sports participation form, camp form
Founder’s Fees
  X A lifetime care advance payment (also known as a founder's fee) is not an eligible medical expense.
Fuel, Gasoline for Medical Care
X The cost of fuel/gas primarily for and essential to medical care, is an eligible medical expense. Fuel/gas expenses are eligible medical expenses if all persons involved are either you, a spouse or an eligible dependent. You must include documentation of the corresponding medical service with your request for reimbursement. Personal car mileage or gasoline primarily for and essential to medicare is eligible. For 2023, the eligible rate is $0.22 per mile. For January 1, 2022 through June 30, 2022, the eligible rate is $0.18 per mile. For July 1, 2022 through December 31, 2022, the eligible rate is $0.22 per mile. Note: Long-distance travel cannot be for purely personal reasons.
Funeral Expenses
  X The cost of a funeral is not an eligible medical expense.

G (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Gambling Treatment
  X A health care professional must provide evidence of medical necessity for the cost of gambling treatment to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Gastric Bypass Surgery Including Excess Skin Removal (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Gastric Bypass Surgery Including Excess Skin Removal (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of removal of excess skin to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Gastric Bypass Surgery Including Excess Skin Removal (for obesity treatment)
X The cost of surgical procedures for obesity treatment is an eligible medical expense. This includes bariatric, gastric bypass and lap band surgery as well as excess skin removal as a result of one of these surgeries.
Gauze Pads
X Gauze pads are an eligible medical expense.
Genetic Testing
X The cost of genetic testing to identify the potential for, or existence of, a medical condition (such as a test for the breast cancer gene) is an eligible medical expense. However, the cost of a DNA test to determine paternity is not an eligible medical expense.
GIFT (Gamete intrafallopian transfer)
  X When associated with an active attempt to conceive, amounts paid for egg and sperm donation, treatment of infertility, and semen and embryo storage (including shots, in-vitro fertilization, GIFT, and artificial insemination) are eligible medical expenses, when recommended by a health care professional as long as you, your spouse or a eligible dependent incurs these expenses due to an underlying medical condition. A health care professional must provide evidence of medical necessity, like a doctor's note or Letter of Medical Necessity (LOMN). You must include the doctor's note or LOMN with your request for reimbursement. That note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Glucosamine and Glucosamine Chondroitin
X The cost of Glucosamine and Glucosamine Chondroitin is an eligible medical expense.
Glucose Monitoring Device
X Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs.
Glucose Tabs
X Amounts paid for diabetic equipment and supplies are eligible medical expenses. These include, but are not limited to: glucose monitor, urine/blood test strips, insulin, syringes, alcohol swabs.
Goggles (prescription)
X The cost of prescription eyeglasses, prescription sunglasses, eye exams, eye patches, reading glasses, OTC reading glasses, tinting of prescription eyewear, prescription goggles and prescription safety glasses are eligible medical expenses. This also includes but not limited to: cataract surgery, Lasik surgery, Corneal Rings.
Guide Dog
X The cost of a guide dog or other animal used by a visually or hearing impaired person, or to assist a person with another disability, is an eligible medical expense.

Amounts paid for the care of a specially trained animal are also eligible medical expenses. This includes any costs incurred in maintaining the animal's health and vitality so that it may perform its duties, such as costs for food, grooming and veterinary care.

Note: The cost of Pet Insurance for the animal is NOT an eligible expense.
Guide Dog (Pet Insurance)
  X The cost of Pet Insurance for the animal is not an eligible expense.
Gynecologist
X The cost of gynecological care is an eligible medical expense.

H (top)
Expense Type
Eligible Requires Letter of Medical Necessity (LOMN) OTC Medicine/ Drug Requires an RX Ineligible Description
Hair Removal or Transplant (for cosmetic reasons)
  X The cost of cosmetic treatment, surgery and procedures is not an eligible medical expense as it does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease. Some examples of cosmetic procedures for the purpose of enhancing one's appearance that are not eligible medical expenses include, but are not limited to: abdominoplasty, bariatric surgery, breast augmentations/reduction, chemical peel, dermabrasion, enhancement, electrolysis (hair removal), face lift, droopy eyelid repair (blepharoplasty), hair transplant, kenalog injections, lap band surgery, liposuction, micro-dermabrasion, restylane injections, rhinoplasty, tattoo removal, and collagen injections.
Hair Removal or Transplant (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of hair removal or a hair transplant to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Half Way House
  X A health care professional must provide evidence of medical necessity for the cost of treatment for alcoholism or substance abuse in a Half Way House to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition.
Hand sanitizer
X Personal protective equipment (PPE) such as masks, hand sanitizer and sanitizing wipes, for the primary purpose of preventing the spread of COVID-19 are eligible medical expenses.
Handicap, Disability Placards and License Plates
X The cost of handicap license plates/placards is an eligible medical expense.
HDHP, High-deductible health plan (premiums)
  X Premiums paid for health and long-term care insurance benefits, including COBRA premiums, fees to belong to a high-deductible health plan (HDHP) and premiums paid as part of a Section 125 payroll reduction plan, are not eligible medical expenses.
Headache Medicine
X The cost of an OTC headache medicine is an eligible medical expense. OTC products include, but are not limited to: Advil, Aleve, Anacin, Aspirin, Doan’s, Excedrin, HeadOn, IMAK, Motrin, Tylenol.
Health Club or Gym Membership Fees (for general health/non-medical)
  X Health club dues paid for general health or to relieve physical or mental discomfort not related to a medical condition are not eligible medical expenses.
Health Club or Gym Membership Fees (for medical condition)
  X A health care professional must provide evidence of medical necessity for the cost of dues paid to a health club or gym to be an eligible medical expense. Include a doctor's note or Letter of Medical Necessity (LOMN) with your request for reimbursement. The doctor's note or LOMN must specifically identify that the recommendation and expense is for treatment of the medical condition. Note: Reimbursement is only for the individual membership and for the component that is related to the current plan year. Any dues that carry over to another plan year must be submitted for that plan year of coverage. Even if you're required to prepay for an entire year, membership fees may only be reimbursed each month.
Health Screenings
X The cost of health screenings/preventive care screenings is an eligible medical expense. Preventive care includes but is not limited to: blood pressure, glaucoma, cataracts, hearing, cholesterol, life line screenings. The cost of a body scan (e.g., an MRI,PET,CAT) and amounts paid for diagnostic services are also eligible medical expenses.
Hearing Aids (over-the-counter)
X