Eligible expenses that require a rx or letter of recommendation.docx

NOTICE REGARDING REIMBURSABLE MEDICAL EXPENSES
PERTAINS TO ITEMS THAT REQUIRE A PRESCRIPTION OR DOCTOR’S NOTE IN ORDER TO
BE CONSIDER ELIGIBLE FOR REIMBURSEMENT
THESE ITEMS CANNOT BE PURCHASED WITH THE HFS DEBIT CARD
This list contains those qualified medical expenses that as of January 1, 2011 require a doctor’s prescription or a
Letter of Medical Recommendation to be eligible from a Medical Flexible Spending Account (FSA), a Healthcare
Reimbursement Account (HRA) and/or a Health Savings Account (HSA). To be reimbursed for these expenses you
will need to submit a claim and include a detailed receipt along with the either a prescription or a Letter of
Recommendation as noted next to the item listed below.
If you have an HRA, your plan may limit your reimbursement to certain qualified medical expenses. Please consult your enrollment materials or contact our customer service department for details. If you have a Limited Medical FSA or a Limited HRA you can only be reimbursed for those items that are considered vision, dental or preventive care. Other HRA Expenses
In addition to the commonly reimbursable medical expenses listed, an HRA may reimburse the following expenses that are not reimbursable under a Medical FSA: Health insurance premiums for current employees, retirees and COBRA qualified beneficiaries
Qualified long-term care insurance contract premiums, subject to certain limitations
If you have an HRA, your plan may limit your reimbursement to certain qualified medical expenses. Please consult your enrollment materials or contact our customer service department for details. Other HSA Expenses
In addition to the commonly reimbursable medical expenses listed, an HSA may reimburse the following expenses that are not reimbursable under a Medical FSA: Continuation coverage under federal law (e.g. COBRA or USERRA coverage) for the account holder, or
the account holder’s spouse or dependents
Qualified long-term care insurance contract premiums, subject to certain limitations
Health insurance premiums for a plan maintained by the account holder or the account holder’s spouse
or dependents while receiving Federal or State unemployment payments
For account holders age 65 or older, any deductible health insurance other than a Medicare supplemental
Acne treatment products - Requires a Prescription
Aleve - Requires a Prescription
Allergy medicines (examples: Actifed, Claritin, Sudafed) - Requires a Prescription
Alternative healer services – Requires a Letter of Medical Recommendation Analgesics (examples: Aspirin, Advil, Motrin) - Requires a Prescription
Antacids and acid reducers (examples: Tums, Mylanta, Zantac 75) - Requires a Prescription
Anti-bacterial hand sanitizer – Requires a Letter of Medical Recommendation Antibiotic ointments and creams (examples: Bacitracin, Neosporin) - Requires a Prescription
Anticandials (examples: Mycelex-7, Monistat 3, V agasil) - Requires a Prescription
Antidiarrheal medicines (examples: Kaopectate, Pepto-Bismol) - Requires a Prescription
Antifungal treatments (examples: Lamisil, Micatin) - Requires a Prescription
Antihistamines (examples: Benadryl, Drixoral, Triaminic) - Requires a Prescription
Antiseptics (examples: Bactine, Lanacane) - Requires a Prescription
Anti-itch lotions (examples: Caldecort, Calamine, Hydrocortisone) - Requires a Prescription
Arthritis pain relievers (examples: Aleve, Aspercreme, Heet) - Requires a Prescription
Aspirin - Requires a Prescription
Asthma medicines (examples: Bronkaid, Primatene Mist) - Requires a Prescription
Bactine - Requires a Prescription
Benzocaine swabs - Requires a Prescription
Blister treatments - Requires a Prescription
Boric acid powder - Requires a Prescription
Bronchial asthma inhalers - Requires a Prescription
Bronchodilator/expectorant tablets - Requires a Prescription
Bufferin - Requires a Prescription
Bug bite medications (example: StingEze) - Requires a Prescription
Bunion treatments - Requires a Prescription
Calamine lotion - Requires a Prescription
Callus remover medications - Requires a Prescription
Car modifications, for physically disabled person - Requires a Letter of Medical Recommendation Chondroitin- Requires a Prescription
Claritin - Requires a Prescription
Cold, products for treatment - Requires a Prescription
Cold sore medications (example: Abreva) - Requires a Prescription
Constipation, products for treatment - Requires a Prescription
Cord blood, storage fees (See Umbilical cord/cord blood) - Requires a Letter of Medical Recommendation Corn removal medication - Requires a Prescription
Corn treatment pads - Requires a Letter of Medical Recommendation Cosmetic procedures and surgery to improve a deformity arising from a medical abnormality, personal injury from accident or trauma, or disfiguring disease - Requires a Letter of Medical Recommendation Cough drops - Requires a Prescription
Cough suppressants (examples: Mucinex DM, Robitussin DM) - Requires a Prescription
Decongestants (examples: Contac, Sudafed) - Requires a Prescription
Diaper rash ointments (examples: Balmax, Desitin) - Requires a Prescription
Diarrhea medicines (examples: Kaopectate, Pepto-Bismol) - Requires a Prescription
Dietary supplements - Requires a Prescription
Disabled dependent care expenses, if medical care - Requires a Letter of Medical Recommendation Diuretics and water pills - Requires a Prescription
DNA collection and storage, collection and temporary storage must be for the diagnosis, treatment or prevention of imminent medical condition- Requires a Letter of Medical Recommendation Ear drops for swimmers - Requires a Prescription
Earache tablets - Requires a Prescription
Ear plugs, for medical condition - Requires a Prescription
Eczema treatments - Requires a Prescription
Elevator, installation to accommodate a disabled individual - (reimbursement is limited to amount above which a property’s value is enhanced by installation of elevator.) - Requires a Letter of Medical Recommendation Excedrin - Requires a Prescription
Exercise equipment - Requires a Letter of Medical Recommendation Exercise program - Requires a Letter of Medical Recommendation Eye drops and products - Requires a Prescription
Feminine hygiene products - Requires a Letter of Medical Recommendation Fever blister medications (example: Herpecin) - Requires a Prescription
Fiber supplements - Requires a Prescription
First aid creams, ointments, sprays and wipes (example: Bactine), - Requires a Prescription
Fish oil supplement (treatment of high cholesterol, etc.) - Requires a Prescription
Fitness program - Requires a Letter of Medical Recommendation Flu relief medicines - Requires a Prescription
Flu shots - Requires a Prescription
Fluoridation device for home water supply - Requires a Prescription
Fluoride rinse - Requires a Letter of Medical Recommendation Food thickeners - Requires a Letter of Medical Recommendation Gas relief and prevention, tablets and drops - Requires a Prescription
Genetic testing to determine medical defects - Requires a Letter of Medical Recommendation Glucosamine - Requires a Prescription
Health club dues (generally not covered if you belonged to club prior to doctor's recommendation) - Requires a Letter of Medical Health institute fees, monies paid to health institute for treatment - Requires a Letter of Medical Recommendation Heart Rate Monitor - Requires a Letter of Medical Recommendation Hemorrhoid treatments, suppositories and creams, prescribed and OTC (examples: Preparation H, Tronolane) - Requires a
Prescription
Herbal medicines - Requires a Prescription
Herbal treatments - Requires a Letter of Medical Recommendation Holistic and natural healer services - Requires a Letter of Medical Recommendation Hormone therapy and treatment for menopause - Requires a Letter of Medical Recommendation House/home improvements to accommodate a disability which generally do not increase property value (e.g., installation of ramps, widening doorways or hallways, installing supports in bathroom, installing lifts, modifying stairways, modifying fire alarms and other warning devices, install handrails and grab bars) - Requires a Letter of Medical Recommendation House/home improvements to accommodate a disability which generally do increase property value (reimbursement limited to amount of expense that exceeds increase in property value) - Requires a Letter of Medical Recommendation Ibuprofen - Requires a Prescription
Inclinator, detachable from property - Requires a Letter of Medical Recommendation Incontinence, products for treatment - Requires a Prescription
Indigestion, products for treatment - Requires a Prescription
Insect bite treatments - Requires a Prescription
Iodine tincture - Requires a Prescription
Ipecac syrup - Requires a Prescription
Itch relief medicines (examples: Caldecort, Calamine, Hydrocortisone) - Requires a Prescription
Lactation consultant services, medical - Requires a Letter of Medical Recommendation Lactose intolerance, products to treat (examples: Dairy Relief, Lactaid) - Requires a Prescription
Language training, dyslexic or disabled individual - Requires a Letter of Medical Recommendation Laxatives (examples: Correctol, Ex-Lax) - Requires a Prescription
Lice control - Requires a Prescription
Loratadine (allergy medicine) - Requires a Prescription
Maalox - Requires a Prescription
Massage therapy - Requires a Letter of Medical Recommendation Mastectomy-related special bra if prescribed by doctor for mental health reasons - Requires a Letter of Medical Recommendation Medical grade face mask - Requires a Letter of Medical Recommendation Medicated chest rub - Requires a Prescription
Medicated shampoo and soap- Requires a Prescription
Menstrual cycle products for pain and cramp relief (examples: Midol, Pamprin) - Requires a Prescription
Mentally handicapped, special home for adjustment to community living- Requires a Letter of Medical Recommendation Motion sickness tablets, pills, etc. (example: Dramamine, Bonine) - Requires a Prescription
Motrin - Requires a Prescription
Muscle or joint pain products (examples: Bengay , Aspircream, Tiger Balm, Icy Hot) - Requires a Prescription
Nasal sprays - Requires a Prescription
Nasal decongestant inhalers - Requires a Prescription
Nasal decongestant drops - Requires a Prescription
Naturopathic services - Requires a Prescription
Necocate, hypo-allergenic infant's formula (reimbursement limited to difference in cost of special formula and ordinary formula) Requires a Prescription
Non-prescription drugs or medicines, for medical care - Requires a Prescription
Nutritionist's professional expenses, treatment for medical condition - Requires a Prescription
Nutritional substances - Requires a Prescription
Orajel - Requires a Prescription
Orthotics, orthopedic inserts - Requires a Letter of Medical Recommendation Over-the-counter medicines to treat medical conditions - Requires a Prescription
Pain reliever (examples: Aspirin, Advil, Excedrin, Bufferin, Motrin, Ibuprofen, Tylenol) - Requires a Prescription
Petroleum jelly - Requires a Prescription
Pin worm treatments - Requires a Prescription
Prilosec - Requires a Prescription
Probiotics - Requires a Prescription
Reflexology- Requires a Letter of Medical Recommendation Rolaids - Requires a Prescription
Rubdown to treat a specific illness - Requires a Letter of Medical Recommendation Sinus medications OTC - Requires a Prescription
Schools and education, special - Requires a Letter of Medical Recommendation Shoe inserts (over-the-counter) to treat injury or weakness - Requires a Letter of Medical Recommendation Sinus medications (example: Sudafed) - Requires a Prescription
- Requires a Prescription
Sinus problems, medicinal products for treatment - Requires a Prescription
Skin products to treat existing skin conditions - Requires a Prescription
Sleep deprivation treatments under the care of doctor - Requires a Prescription
Sleeping aids, over-the-counter - Requires a Prescription
Special foods, if prescribed by a doctor to treat a specific illness or condition (Reimbursement limited to difference between cost of the special food and the ordinary version of that food) - Requires a Letter of Medical Recommendation Sperm, storage fees, temporary storage aimed at immediate conception (no longer than one year) - Requires a Letter of Medical Spermicide - Requires a Prescription
Stem cell harvesting and storage of , to treat a specific and imminent medical condition - Requires a Letter of Medical Recommendation Sublimed sulfur powder - Requires a Prescription
Sunburn treatment, lotions and creams - Requires a Prescription
Sunscreen - Requires a Prescription
Supplements (examples: Glucosamine/Chondroitin for arthritis, St. John's Wort for depression) - Requires a Prescription
T anning, salon or equipment to treat a specific medical condition - Requires a Letter of Medical Recommendation T eething pain reliever (examples: Little T eethers, Orajel) - Requires a Prescription
T elevision for hearing impaired person (limited to the cost of special closed-captioning equipment as an add-on, or the part of the cost of a specially equipped television set that exceeds the cost of the same model regular television set) - Requires a Letter of Medical Recommendation Throat pain medications (examples: Chloraseptic, Sucrets) - Requires a Prescription
Throat lozenges and sprays (examples: Sucrets. Chloraseptic, etc.) - Requires a Prescription
T oothache medicines (examples: Anbesol, Orajel) - Requires a Prescription
Transportation for someone other than person receiving medical care, parents and nurse accompanying patient, or transportation relating to visits to a mentally ill dependent if it is part of treatment - Requires a Letter of Medical Recommendation Treadmill, if prescribed by doctor to treat a medical condition - Requires a Letter of Medical Recommendation Tums - Requires a Prescription
Tuition for attending a school recommended by a doctor that furnishes special education to help a child overcome a learning disability. Overcoming a learning disability must be the principal reason the child attends the school (also covers meals and lodging at such school) - Requires a Letter of Medical Recommendation Tuition for special needs program (tutoring by a teacher that is specially trained to work with children with learning disorders caused by mental or physical impairments) - Requires a Letter of Medical Recommendation Tutoring for special needs (See Tuition for special needs program) - Requires a Letter of Medical Recommendation Tylenol - Requires a Prescription
Umbilical cord/cord blood, freezing and storage of - collection and storage for imminent use to treat a specific medical condition - Requires a Letter of Medical Recommendation Upset stomach medications (examples: Alka Seltzer, Mylanta) - Requires a Prescription
V apor patch cough suppressants - Requires a Prescription
V aricose veins, non-cosmetic treatment of - Requires a Letter of Medical Recommendation Visine - Requires a Prescription
Vitamins, over-the-counter - Requires a Prescription
Wart removal products (examples: Compound W, Wartner) - Requires a Prescription
Weight loss drugs - Requires a Prescription
Weight loss program - Requires a Letter of Medical Recommendation Wigs, for mental health of patient who has lost hair - Requires a Letter of Medical Recommendation

Source: http://www.hfsbenefits.com/participants/eligible_expenses_wrequirements.pdf