Eligible Expenses
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Title |
Description | Eligible | Additional Requirement | Account |
|---|---|---|---|---|
| Athletic Mouth Guards | No | HSA, Limited Scope FSA, Health Care FSA | ||
| Co-Payments | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Contact Lens Solution | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Contact Lenses | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Crowns, Dental | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Deductibles | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Dental Care, cosmetic | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Dental Floss | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Dental Implants | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Dental Records Charges | Yes | Limited Scope FSA | ||
| Dental Sealants | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Dental Treatment | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Dental X-Ray Fees | Yes | Limited Scope FSA | ||
| Denture Brush | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Denture Cleaners | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Dentures and Denture Adhesives | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Diet Foods | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Discount Programs | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Eye Drops | Yes | RX | Health Care FSA, HSA, Limited Scope FSA | |
| Eye Examinations, Eyeglasses, Equipment, Materials, and Repair | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Finance Charges | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Flouride Rise | Yes | RX | Health Care FSA, HSA, Limited Scope FSA | |
| Glasses | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Illegal Operations and Treatments | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Lab Fees | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Laser Eye Surgery; Lasik | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Late Fees | No | Dependent Care FSA, Health Care FSA, HSA, Limited Scope FSA | ||
| Late Payment Fees | No | Dependent Care FSA, Health Care FSA, HSA, Limited Scope FSA | ||
| Missed Appointment Fees | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Mouthwash | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Occlusal guards | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Online or Telephone Consultation |
Medical practitioner's fee |
Yes | Health Care FSA, HSA, Limited Scope FSA | |
| Operations | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Optometrist | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Oral Care Products |
e.g. Anbesol, Orajel |
Yes | RX | Health Care FSA, HSA, Limited Scope FSA |
| Orthodontia | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Parking Fees and Tolls |
Related to medical care received |
Yes | Health Care FSA, HSA, Limited Scope FSA | |
| Prescription Drugs/Medicines | Yes | RX | Health Care FSA, HSA, Limited Scope FSA | |
| Product Replacement Plans/Warranties | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Reading Glasses | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Safety Glasses | Yes | RX | Health Care FSA, HSA, Limited Scope FSA | |
| Shipping and Handling Fees | Yes | Health Care FSA, HSA, Limited Scope FSA | ||
| Subway Fare |
In connection with medical care received |
Yes | Health Care FSA, HSA, Limited Scope FSA | |
| Taxes on Dental Services and Products | Yes | Limited Scope FSA | ||
| Taxi Fare |
In connection to medical care received |
Yes | Health Care FSA, HSA, Limited Scope FSA | |
| Teeth Whitening | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Toll bridges |
In connection with medical care received |
Yes | Health Care FSA, HSA, Limited Scope FSA | |
| Toothache/Teething Pain Relievers | Yes | RX | Health Care FSA, HSA, Limited Scope FSA | |
| Toothbrushes | No | Health Care FSA, HSA, Limited Scope FSA | ||
| Toothpaste | No | Health Care FSA, HSA, Limited Scope FSA |
Note: Due to frequent IRS updates to the regulations governing FSAs and HSAs, this list is to be utilized only as a general guide for the submission of claims. Please refer to your employer's Summary Plan Description (SPD) for your specific plan details.
