Microsoft word - fsa eligible ineligible services.doc

Eligible & Ineligible Healthcare FSA Expenses
Important Reminder
Vision/Hearing
Diagnostic/Preventative
Eligible:
Eligible:
Eligible:
Ineligible:
more examples) NOTE:
Miscellaneous Charges
Ineligible:
Eligible:
Ineligible:
Equipment
Eligible:
Procedures/Treatments
Eligible:
Eligible:
Ineligible:
NOTE: Foods associated with
Psychiatric Care
Eligible:
Ineligible:
Ineligible:
Ineligible:
Assistance for the Disabled
Eligible:
Insurance
Eligible:
Ineligible
Ineligible:
NOTE: Acne treatments and
F L E X I B L E C O R P O R A T E P L A N S
P.O. Box 381717, Birmingham, Alabama 35238 ¡ Toll free (888) 505-4557/ Local (205) 995-1222 ¡ Toll free fax (866) 238-8224/Local fax (205) 995-4099 Eligible Over-the-Counter Medications
O V E R - T H E - C O U N T E R D R U G S U S E D P R I M A R I L Y F O R M E D I C A L C A R E
The follow medications are FSA eligible; no recommendation from your healthcare provider is required. T Y P E O F D R U G
E X A M P L E S *
Benadryl, Sudafed, Actifed, Claritin, Chlora Trimaton, Nasalcrom Gas-X, Maalox, Mylanta, Tums, AXID AR, Pepcid AC, Prilosec OTC, Tagamet HB, Zantac 75AXID Femstat 3, Gyne-Lotrimin, Mycelrx-7, Monistat, Vagistat Actidil Syrup and Capsules, Actifed, Allerest, Benadryl, Claritin, Chlor-Trimeton, Contac, Dimetane, Drixoral, Nyquil, Sudafed, Tavist-1, Triaminic Ex-Lax, Pepto-Bismol, Immodium A.D., Kaopectate Lamisil AT, Lotramin AF, Micatin, Anti-itch Lotions and Creams (e.g., for athletes foot, Bactine, Caldecort, Cortaid, Hydrocortisone, Lanacort, Calamine Lotion, Benadryl Cream, Caladryl, Cortaid, Lamisil AT, Lotramin AF, Micatin Trojans, Magnum, VGF Film, Delfen Contraceptive Foam Bausch & Lomb, Renu, Aosept, Allergan, Boston, Opti-Free Robitussin, Vicks 44, Chloraseptic Decongestant/ Nasal Decongestant and Cold Advil Cold and Sinus, Afrin, Afrinol, Aleve Cold and Synus, Children’s Advil Cold, Duration, Dristan Long Lasting, Neo-Synephrine-12 Hour, Orrivin, Sudafed, Tavist-D, Tylenol Cold and Flu, Thera-flu, Alka Seltzer Cold and Flu, Nyquil, Actidil Syrup and Capsules, Actifed, Allerest, Benadryl, Claritin, Chlor-Trimeton, Contac, Dimetane, Drixoral, Sudafed, Tavist-1, Triaminic Ace Bandages, Band-Aids, Bandage Tape, Thermometers, Medical Gloves, Gauze, Neosporin, Rubbing Alcohol, Visine Preparation H, Hemorid, Tronolane Advil, Aleve, Children’s Motrin, Nuprin, Excedrin, Tylenol, Bayer Services and Bracelets specifically for medical information Blood Pressure Monitor, Glucose Tester, HIV Test, Cholesterol Test, Diabetic Supplies, Crutches, Ovulation Monitor, Pregnancy Testing Kits Advil Migraine, Liqui-gels, Excedrin Migraine, Motrin Migraine Nicotine Gum, Patches & Smoking Cessation Aids Nicorette, Nicotrol, Nicodin, Nicoderm CQ, Commit *This list is not an exhaustive list and is intended to give examples of some of the most common brand names of OTC drugs. All of the above Brand Name Products are Registered Marks of the corresponding manufacturers.

Source: http://www.mylifeatchildrens.com/Portals/0/pdf/Eligible_&_Ineligible_FSA_Expenses.pdf