Eligible Expenses

General Eligibility List For Items & Services

Note: Pre-payment for services is not allowed. All expenses must be incurred prior to payment with 24HourFlex card or prior to requesting reimbursement from your FSA.  For a more detailed and complete list, please refer to the FSAStore.com eligibility list.

Resoureces: Letter of Medical NecessityOver the Counter Prescription Template

 

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As per the FSA Store, items will be marked as:

Key

 

Acne treatments (OTC) rx
Acupuncture check
Adoption (medical expenses related to) check
Adoption fees Not Elig.
Advil rx
Air conditioner (amount in excess of value enhancement to property) LOMN
Air purifier LOMN
Alcoholism treatment check
Allergy and sinus medicine and products (OTC) rx
Allergy medication rx
Allergy treatments and products LOMN
Alternative dietary supplements (for treatment of a medical condition) LOMN
Alternative drugs, medicines and treatment products (for treatment of a medical condition) LOMN
Alternative healers (for treatment of a medical condition) LOMN
Ambulance and emergency health services check
Anesthesia (for noncosmetic purposes) rx
Antacid (OTC) rx
Antibiotic ointment (OTC) rx
Antihistamines (OTC) rx
Arthritis gloves (OTC) check
Artificial limbs check
Artificial teeth check
Aspirin or other pain reliever (OTC) rx
Asthma medicines or treatments (OTC) rx
Athletic treatments/braces check
Automobile modifications LOMN
Bactine (OTC) rx
Bandages and related items (OTC) check
Birth control (OTC) rx
Birth control (prescription or other) check
Blood pressure monitor check
Body scans check
Braille books and magazines (difference in cost only) check
Breast pump (for a lactating woman) check
Breast reconstruction surgery (following mastectomy) rx
Breastfeeding classes check
Calamine lotion (OTC) rx
Cancer (fixed indemnity) insurance premiums Not Elig.
Canker and cold sore treatments (OTC) rx
Car modifications (as required for a medical condition diagnosed by a licensed healthcare professional) LOMN
Carpal tunnel wrist supports (OTC) check
Cayenne pepper (OTC) LOMN
Chelation therapy LOMN
Chest rubs (OTC) rx
Child or newborn care instruction Not Elig.
Childbirth classes (charges for mother only) check
Chiropractic care check
Chiropractic office visit or treatment check
Cholesterol test kits and supplies check
Chondroitin LOMN
Christian Science practitioners check
Circumcision check
COBRA premiums (dental; paid with after-tax dollars only) Not Elig.
COBRA premiums (medical; paid with after-tax dollars only) Not Elig.
COBRA premiums (other; paid with after-tax dollars only) Not Elig.
COBRA premiums (prescription; paid with after-tax dollars only) Not Elig.
COBRA premiums (vision; paid with after-tax dollars only) Not Elig.
Co-insurance (dental) check
Co-insurance (medical) check
Co-insurance (prescription) check
Co-insurance (vision) check
Cold and flu medicine (OTC) rx
Cold and flu prevention (OTC) rx
Cold cream (OTC) Not Elig.
Cold/hot packs (sold as medical supplies) check
Compression or anti-embolism socks, stockings or hose check
Concierge medical fees (billed for actual services received) check
Concierge medical fees (billed for future availability of services, with no services actually received) Not Elig.
Condoms check
Contact lenses and solutions check
Contraceptives (OTC) check
Contraceptives (prescription) check
Copayment (dental) check
Copayment (medical) check
Copayment (prescription) check
Copayment (vision) check
Cord blood storage (for future treatment of a birth defect or known medical condition) LOMN
Cord blood storage (for unidentified future use) Not Elig.
Corn and callus remover (OTC) rx
Corneal keratotomy check
Cosmetic procedures or surgery Not Elig.
Cosmetic procedures or surgery for birth defects, accidents, and/or disease LOMN
Cosmetics (OTC) Not Elig.
Cough drops and sore throat lozenges (OTC) rx
Cough syrup (OTC) rx
Counseling (for treatment of a medical condition) check
Counseling (marriage) Not Elig.
CPR classes (adult or child) Not Elig.
Crowns, dental (for treatment of a medical condition) check
Crutches, canes, walkers or like equipment (purchase or rental) check
Dancing lessons (for treatment of a medical condition) LOMN
Decongestants (OTC) rx
Deductible for dental plan check
Deductible for medical plan check
Deductible for prescription plan check
Deductible for vision plan check
Dental care (for non-cosmetic purposes, including sealants) check
Dental co-insurance check
Dental co-payment check
Dental insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Dental products for general health Not Elig.
Dental reconstruction (including implants) check
Dental sealants check
Dental veneers LOMN
Dental, oral, and teething pain products (OTC) rx
Dentures, denture adhesives, bridges, etc. check
Deodorant (OTC) Not Elig.
Dermatology treatments and products LOMN
Diabetic monitors, test kits, strips and supplies check
Diabetic socks (OTC) LOMN
Diagnostic services (dental or vision) check
Diagnostic services (other than dental or vision) check
Diaper rash ointments and creams (OTC) rx
Diapers and diaper services Not Elig.
Diarrhea medicine (OTC) rx
Dietary supplements (for treatment of a medical condition) LOMN
Diet foods (OTC) Not Elig.
Doula or birthing coach LOMN
Drug addiction treatment check
Drug overdose, treatment of check
Drugs (imported) Not Elig.
Drugs and medicines (OTC) rx
Dyslexia treatment LOMN
Ear drops and wax removal (OTC) rx
Ear piercing Not Elig.
Ear plugs (OTC) LOMN
Eczema treatments (OTC) rx
Egg and embryo storage fees (for immediate use) LOMN
Electrolysis Not Elig.
Elevator (amount in excess of value enhancement to property) LOMN
Emergency kits (OTC) Not Elig.
Exercise equipment or program (as treatment for a medical condition diagnosed by a licensed healthcare professional) LOMN
Expectorants (OTC) rx
Eye drops and treatments (OTC) rx
Eye examinations check
Eye related equipment/materials check
Eye surgery or treatment to correct vision check
Eyeglasses (prescription) check
Face creams (OTC) Not Elig.
Face lifts Not Elig.
Feminine hygiene products Not Elig.
Fertility monitor (OTC) check
Fertility treatment (for employee, spouse or dependent) check
Fertility treatment (for non-dependent surrogate) Not Elig.
Fever-reducing medications (OTC) rx
Fiber supplements (OTC) rx
First aid cream (OTC) rx
First aid kits (OTC) check
Fitness programs (as treatment for a medical condition diagnosed by a licensed healthcare professional) LOMN
Flu shots check
Fluoridation services check
Fluoride rinses (OTC) LOMN
Food thickeners (OTC) LOMN
Funeral expenses Not Elig.
Gastrointestinal medication (OTC) rx
Gauze pads (OTC) check
Glucosamine (OTC) LOMN
Glucose-monitoring equipment (OTC) check
Guide dog; other service animal (dog, training, care) check
Hair colorants (OTC) Not Elig.
Hair regrowth products Not Elig.
Hair removal Not Elig.
Hair transplant Not Elig.
Hair treatments Not Elig.
Hand lotion (OTC) Not Elig.
Hand sanitizer (OTC) LOMN
Headache medications (OTC) rx
Health club dues (as treatment for a medical condition diagnosed by a licensed healthcare professional) LOMN
Health insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Health Savings Account (HSA) contributions Not Elig.
Hearing aids and batteries check
Hemorrhoid treatments (OTC) rx
Herbal or homeopathic medicines (OTC) LOMN
Holistic or natural healers, dietary substitutes, and drugs and medicines LOMN
Home improvements (as required for a medical condition diagnosed by a licensed healthcare professional) LOMN
Hormone replacement therapy (HRT) LOMN
Hospital (fixed indemnity, $x per day) insurance premiums Not Elig.
Hospital services and fees check
Household help Not Elig.
Humidifier, air filter and supplies LOMN
Hypnosis LOMN
Illegal surgeries or substances Not Elig.
Immunizations check
Inclinator (amount in excess of value enhancement to property) LOMN
Incontinence supplies check
Individual dental insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Individual medical insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Individual prescription insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Individual vision insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Infertility treatment (for employee, spouse or dependent) check
Insect-bite creams and ointments (OTC) rx
Insulin, testing materials and supplies check
Insurance/plan premiums (paid with pre-tax dollars) Not Elig.
Lab (medical) check
Laboratory fees check
Lactation consultant LOMN
Lactose intolerance medication (OTC) rx
Lamaze classes (charges for mother only) check
Language training LOMN
Laser eye surgery; Lasik check
Late payment fees charged by healthcare provider Not Elig.
Laxatives (OTC) rx
Learning disability treatments check
Lice treatment (OTC) rx
Lipsticks (OTC) Not Elig.
Liquid adhesive for small cuts (OTC) check
Listening therapy check
Lodging (limited to $50 per night for patient to receive medical care and $50 per night for one caregiver) LOMN
Long-term care premiums (up to IRS tax-free limit, see IRS Publication 502) Not Elig.
Long-term care services Not Elig.
Long-term disability insurance premiums Not Elig.
Magnetic therapy (OTC) LOMN
Makeup (OTC) Not Elig.
Marijuana or other controlled substances in violation of federal law Not Elig.
Masks, disposable (OTC) LOMN
Massage therapy (for treatment of a medical condition) LOMN
Mastectomy-related special bras check
Maternity clothes Not Elig.
Mattresses (difference in cost only of specialized mattress over like non-specialized mattress)  LOMN
Medical abortion check
Medical alert bracelet or necklace check
Medical equipment (for treatment of medical condition) and repairs check
Medical insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Medical literature, books, pamphlets or audio Not Elig.
Medical monitoring and testing devices check
Medical records charges check
Medical savings account (MSA) contributions Not Elig.
Medical services check
Medical supplies (for treatment of a medical condition) check
Medicare alternative insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Medicare alternative insurance/plan premiums (vs. Part A & Part B, paid with after-tax dollars only) Not Elig.
Medicare Part B insurance Not Elig.
Medicare supplement policy premiums Not Elig.
Menstrual pain relievers (OTC) rx
Midwife check
Mileage (for travel to/from anything other than eligible care) Not Elig.
Mileage (for travel to/from eligible healthcare) check
Mineral supplements (OTC) LOMN
Missed appointment fees (OTC) Not Elig.
Modified equipment (difference in cost only) LOMN
Moisturizers (OTC) Not Elig.
Monitors and test kits (OTC) check
Morning-after contraceptive pills rx
Motion sickness medication (OTC) rx
Mouthwash (OTC) Not Elig.
MRI check
Nail polish (OTC) Not Elig.
Nasal sprays rx
Nasal strips (OTC) rx
Naturopathic healers, dietary substitutes and drugs and medicine LOMN
Nicotine gum or patches (OTC) rx
No show fees charged by healthcare provider Not Elig.
Non-prescription drugs and medicines (for non-cosmetic purposes) rx
Norplant insertion or removal check
Nursing services (wages and taxes) check
Nutritional supplements (for treatment of a medical condition) LOMN
Nutritionist LOMN
OB/GYN fees check
Obstetrical expenses check
Occlusal guards to prevent teeth grinding check
Occupational therapy (related to a medical condition or disability) check
Office visits (chiro) check
Office visits (dental) check
Office visits (medical) check
Office visits (psych/therapy) check
Office visits (vision) check
Operations (for non-cosmetic purposes) check
Operations (for vision and dental only) check
Optometrist/ophthalmologist fees check
Organ transplants (recipient and donor) check
Ortho keratotomy check
Orthodontia (braces and retainers) check
Orthopedic and surgical supports check
Orthopedic shoe inserts check
Orthopedic shoes (difference in cost only of specialized orthopedic shoe over like non-specialized shoe) LOMN
Orthotics check
Osteopath fees check
OTC acne treatments rx
OTC allergy & sinus medicine rx
OTC antacid rx
OTC antibiotic ointment rx
OTC aspirin or other pain reliever rx
OTC asthma medicines or treatments rx
OTC bandages and related items check
OTC canker & cold sore treatments rx
OTC chest rubs rx
OTC cold & flu medicine rx
Ovulation monitor (OTC) check
Oxygen check
Pain relievers (OTC) rx
Parental fees (billed for actual services received; for disabled children) check
Parental fees (billed for future availability of services, with no services actually received; for disabled children) Not Elig.
Perfume (OTC) Not Elig.
Petroleum jelly (OTC) LOMN
Physical exams check
Physical therapy check
Physician retainer fee (for on-call or concierge services) Not Elig.
Pregnancy tests (OTC) check
Prenatal vitamins check
Prepayments Not Elig.
Prescription co-insurance check
Prescription co-payment check
Prescription drugs (for non-cosmetic purposes) check
Prescription drugs for cosmetic purposes Not Elig.
Preventative care screenings check
Probiotics (OTC)  LOMN
Propecia (for treatment of a medical condition) rx
Prosthesis check
Psych/therapy check
Psychiatric care check
Psychoanalysis check
Radial keratotomy (RK) check
Reading glasses (OTC) check
Recliner chairs Not Elig.
Rehydration solution (OTC) check
Removal of benign mole, cyst, or tumor check
Retainer fee (to physician for on-call or concierge services) Not Elig.
Retin-A (for non-cosmetic purposes) LOMN
Rogaine or other hair regrowth medications LOMN
Rubbing alcohol (OTC) rx
Rubdowns LOMN
Safety glasses (non-prescription) Not Elig.
Sales tax, shipping and handling fees (for any eligible expense) check
Saline nasal spray check
Screening tests check
Seeing-eye dog check
Shampoos (OTC) Not Elig.
Shaving cream or lotion (OTC) Not Elig.
Sinus medications (OTC) rx
Sinus rinse check
Sitz bath check
Skin moisturizers (OTC) Not Elig.
Sleep aids and sedatives (OTC) rx
Sleep-deprivation treatment check
Smoking cessation (programs/counseling) check
Smoking cessation drugs (prescription) check
Smoking cessation gum or patches (OTC) rx
Soaps (OTC) Not Elig.
Special equipment LOMN
Special foods (gluten-free, salt-free or other for treatment of a medical condition; difference in cost only) LOMN
Special school (for mental and physical disabilities) LOMN
Sales tax, shipping and handling fees (for any eligible expense) check
Speech therapy check
Spermicidals rx
Sperm storage fees (for immediate use) LOMN
Stem cell, harvesting and/or storage of (for immediate use) LOMN
Sterilization rx
St. John;s Wort rx
Student health fees for dental services (billed for actual services received) check
Student health fees for dental services (no services actually received; billed for future availability of services) Not Elig.
Student health fees for medical services (billed for actual services received) check
Student health fees for medical services (no services actually received; billed for future availability of services) Not Elig.
Student health fees for prescription services (no services actually received; billed for future availability of services) Not Elig.
Student health fees for prescriptions (billed for actual services received) check
Student health fees for vision services (billed for actual services received) check
Student health fees for vision services (no services actually received; billed for future availability of services) Not Elig.
Sunburn creams and ointments (OTC) rx
Sunglasses (OTC) Not Elig.
Sunglasses (prescription) check
Sunscreen with SPF <15 or suntan lotion (OTC) Not Elig.
Sunscreen with SPF 15+ and “broad spectrum”, sunburn creams and ointments (OTC) check
Supplies (for treatment of a medical condition) check
Support braces (OTC) check
Surgery (for non-cosmetic purposes) check
Swimming lessons (for treatment of a medical condition) LOMN
Tampons Not Elig.
Tanning salons and equipment Not Elig.
Tattoo removal Not Elig.
Teeth bleaching or whitening Not Elig.
Telephone for hearing-impaired persons check
Television for hearing-impaired persons check
Therapy check
Thermometers check
Throat lozenges (OTC) rx
Toiletries (OTC) Not Elig.
Toothache and teething pain relievers (OTC) rx
Toothpaste, medicated (difference in cost only of medicated toothpaste over the standard toothpaste) rx
Toothpaste, toothbrush, floss, etc. Not Elig.
Transgender treatments/surgery LOMN
Transplants check
Transportation, parking and related travel expenses (essential to receive eligible care) check
Transportation, parking and related travel expenses, for non-eligible expenses Not Elig.
Treadmill LOMN
Tubal ligation check
Tuition or educational classes (for a specific medical condition) LOMN
Tylenol rx
Ultrasound (for medical care) check
Ultrasound, prenatal check
Umbilical cord, freezing and storing of (for immediate use) LOMN
Urinalysis check
Urological products check
UV protection clothing Not Elig.
UVR treatments LOMN
Vaccinations check
Varicose vein removal surgery (for medical care) check
Vasectomy check
Vasectomy reversal check
Veneers Not Elig.
Veterinary fees Not Elig.
Viagra and similar prescription medications check
Vision care check
Vision correction check
Vision discount programs Not Elig.
Vision insurance/plan premiums (paid with after-tax dollars only) Not Elig.
Vision products (OTC) check
Vitamins (prescription) check
Vitamins for general health purposes (OTC) Not Elig.
Walking aids (canes, walkers, crutches and related supplies) check
Warranties or other charges for future anticipated services (with none actually received) Not Elig.
Wart removal treatments (OTC) rx
Weight loss counseling LOMN
Weight loss drugs (for treatment of a medical condition) rx
Weight loss foods Not Elig.
Weight loss program (for treatment of a medical condition) LOMN
Weight loss program (to improve or maintain general health) Not Elig.
Wheelchair and repairs check
Wigs (OTC) LOMN
Wound care (OTC) check
X-ray fees (dental) check
X-ray fees (medical) check
Yeast infection medications (OTC) rx

 

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