Simpson.k12.ky.us

The fol owing are examples of IRS al owable and disal owed healthcare expenses for a Healthcare Flexible Spending Account (FSA). Note: This is only a list of examples. The IRS could al ow or disal ow items depending on facts or circumstances. Plan restrictions may apply. Check with your employer for specifics that apply
to your benefit plan. For further guidance, refer to Internal Revenue Service (IRS) section 213(d). This
publication is available at your public library or from the IRS.
Your plan may have additional restrictions and entire categories of eligible items may not qualify
Prescription Drugs:
• Allowable Expenses
• Specifically Disallowed
– Nonprescription drugs, vitamins, or il egal drugs Medical Equipment:
• Allowable Expenses
– Wheelchair or automate (cost of operating/maintaining) – Special mattress and plywood boards prescribed to al eviate arthritis – Oxygen equipment and oxygen used to relieve breathing problems that result from a medical condition – Support hose (if medical y necessary) – Wigs when necessary for mental health or prescribed by a doctor for an individual who loses hair – Excess cost of orthopedic shoes over the cost of ordinary shoes • Specifically Disallowed
– Wigs, when not medical y necessary for mental health – Vacuum cleaner purchased due to dust al ergy Treatments and Therapies:
• Allowable Expenses
– Treatment for alcoholism or drug dependency – Physical therapy (as a medical treatment) • Specifically Disallowed
– Physical treatments unrelated to specific health problem (e.g., massage for general wel -being) – Stop-smoking programs for general wel -being Humana.com
Physicals:
• Allowable Expenses
Fees/Services:
• Allowable Expenses
– Nursing services for care of a specific medical ailment – Cost of a nurse’s room and board when nurse’s services qualify – Social Security tax paid with respect to wages of a nurse when a nurse’s services qualify – Cosmetic surgery or procedures that treat a deformity caused by an accident, trauma, disease, or an • Specifically Disallowed
– Cosmetic surgery or procedures that improve the patient’s appearance but do not meaningful y promote the proper function of the body or prevent or treat an il ness or a disease – Payments to domestic help, companion, baby-sitter, chauffeur, etc. who primarily renders services of a – Nursemaids or practical nurses who render general care for healthy infants – Fees for exercise, athletic, or health club membership, when there’s no specific health reason – Marriage counseling provided by a member of the clergy Dental and Orthodontic Care:
• Allowable Expenses
– Cost of fluoridation of home water supply advised by dentist • Specifically Disallowed
– Tooth bonding that isn’t medical y necessary Vision Care:
– Optometrist’s or ophthalmologist’s fees – Contact lenses and cleaning solutions • Specifically Disallowed
Hearing Care:
• Allowable Expenses
– Batteries for hearing aids
Assistance for the Handicapped:
• Allowable Expenses
– Cost of note-taker for a deaf child in school – Cost of Brail e books and magazines in excess of cost of regular editions – Guide dog (cost of buying, training, and maintaining) – Hearing-trained cat or other animal to assist deaf person (cost of buying, training, and maintaining) – Household visual alert system for deaf person – Excess costs of specifical y equipping automobile for handicapped person over the cost of ordinary automobile; device for lifting handicapped person into automobile – Special devices, for a blind person such as tape recorder and typewriter
Psychiatric Care:
• Allowable Expenses
– Services of psychotherapists, psychiatrists, and psychologists – Psychiatric therapy for sexual problems – Legal fees directly related to commitment of a mental y il person • Specifically Disallowed
– Psychoanalysis undertaken to satisfy curriculum requirements of a student Miscellaneous Charges:
• Allowable Expenses
– Expenses for services connected with donating an organ – Cost of computer storage of medical records – Cost of a special diet, but only if it’s medical y necessary and only to the extent that costs exceed that of – Transportation expenses primarily for and essential to medical care, including bus, taxi, train, plane fares, ambulance services, parking fees, and tol s – Amounts paid for meals during inpatient care at a hospital or similar institution, if the main reason for – Lodging expenses (not provided in a hospital or similar institution) while away from home if al of the 1. Lodging is primarily for and essential to medical care.
2. Medical care is provided by a doctor in a licensed hospital or in a medical care facility related to, or the 3. Lodging is not lavish or extravagant under the circumstances.
4. There’s no significant element of personal pleasure, recreation, or vacation in the travel away 5. The amount included in medical expenses can’t exceed $50 for each night for each person. Lodging is included for a person for whom transportation expenses are a medical expense because that person is traveling with the person receiving medical care. For example, if a parent is traveling with a sick child, up to $100 per night is included as a medical expense for lodging (meals are not • Specifically Disallowed
– Expenses of divorce when doctor or psychiatrist recommends divorce – Cost of toiletries, cosmetics, and sundry items (e.g., soap, toothbrushes) – Cost of special foods taken as a substitute for regular diet, when the special diet is not medical y necessary or cost is not in excess of a normal diet – Distil ed water purchased to avoid drinking fluoridated city water supply – Instal ation of power steering in an automobile – Pajamas purchased to wear in hospital – Mobile telephone used for personal phone cal s as wel as cal s to a doctor – Insurance against loss of income or loss of life, limb, or sight – Union dues for sick benefits for members – Contributions to state disability funds – Premiums for insurance coverage, including auto insurance providing medical coverage – Capital expenditures (e.g., construction costs, elevators, swimming pool, or hot tub) Over-the-Counter (OTC) MedicationsGeneral y, FSA funds can be used for eligible over-the-counter (OTC) items. Some employers have restrictions on certain OTC items, and most employers do not permit Personal Care Account (PCA) funds to be used for OTC items. For more information on your particular plan, contact your employer or cal the FSA/PCA/HSA phone number on the back of your Humana ID card.
Over-the-counter medications such as pain relievers, cough syrup, and al ergy medicines require a prescription in order to be eligible for reimbursement from an FSA or PCA. The HumanaAccess Card cannot be You can continue to use your card for OTC items that are not medications. Your ability to use your card • Your employer’s plan restrictions. • Whether the item is an OTC medication • IRS rules governing the use of payment cards like the HumanaAccess Card.
• The merchant’s ability to systematical y comply with the IRS rules. More about merchant systems If you pay out of pocket, be sure to save your receipts,
Require Prescription:
Antiseptics
Skin Care
Health Aids
Asthma Medications
Pain Relief
Ear/Eye Care
Cold, Flu, and Allergy
Medications
Stomach Care
Over-the-Counter (OTC) MedicationsGeneral y, FSA funds can be used for eligible over-the-counter (OTC) items. Some employers have restrictions on certain OTC items, and most employers do not permit Personal Care Account (PCA) funds to be used for OTC items. For more information on your particular plan, contact your employer or cal the FSA/PCA/HSA phone number on the back of your Humana ID card.
Over-the-counter medications such as pain relievers, cough syrup, and al ergy medicines require a prescription in order to be eligible for reimbursement from an FSA or PCA. The HumanaAccess Card cannot be You can continue to use your card for OTC items that are not medications. Your ability to use your card • Your employer’s plan restrictions. • Whether the item is an OTC medication • IRS rules governing the use of payment cards like the HumanaAccess Card.
• The merchant’s ability to systematical y comply with the IRS rules. More about merchant systems If you pay out of pocket, be sure to save your receipts, No Prescription Required:
Skin Care
Health Aids
Personal Test Kits
Ear/Eye Care
Diabetes
Dual Use – requires letter of medical necessity:
Not Eligible:
Humana.com

Source: http://www.simpson.k12.ky.us/userfiles/638/HRA%20%20FSA%20Sample%20Expenses.pdf