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					                       Health Care FSA Qualifying Expenses

Acupuncture                                              Laboratory fees
Ambulance                                                Laser eye surgery; Lasik
Artificial limbs                                         Mastectomy-related special bras
Artificial teeth                                         Medical records charges
Asthma treatments                                        Obstetrical expenses
Bandages, elastic                                        Occlusal guards to prevent teeth
Bandages, for torn or injured skin                       grinding
Birth Control                                            Optometrist
Blood-pressure monitoring devices                        Orthodontia
Body Scans                                               Osteopath fees
Chiropractors                                            Oxygen and oxygen equipment
Co-insurance amounts                                     Physical exams
Cold packs sold as medical supply                        Physical therapy
Condoms                                                  Pregnancy test kits
Contact lenses and contact lens                          Prescription drugs
solutions                                                Preventive care screenings
Contraceptives                                           Prosthesis
Co-payments                                              Psychiatric care
Crowns, dental                                           Reading glasses
Crutches                                                 Screening tests
Deductibles                                              Speech therapy
Dental Sealants                                          Smoking cessation programs
Dental treatment                                         Sunglasses, prescription
Dentures and denture adhesives                           Support braces
Diabetic supplies                                        Surgery
Diagnostic items/services                                Telephone for hearing impaired
Eye examinations                                         persons
Eye glasses                                              Therapy
Flu shots                                                Thermometers
Fluoridation services                                    Transplants
Gauze pads                                               Vaccines
Hearing aids                                             Vasectomy
Heating pads or hot packs                                Vasectomy reversal
Hospital services                                        Walkers
Immunizations                                            Wheelchair
Incontinence supplies                                    X-ray fees

               Stirling Benefits, Inc. | 20 Armory Lane | Milford, CT 06460
                       1.800.447.6689 |
                                            Potentially Qualifying Expenses
      Will require a letter of medical necessity from a physician or other documentation indicating expense incurred to
                                              treat a diagnosed medical condition

          Adaptive equipment                                                           Humidifier
          Automobile modifications                                                     Learning disability, instructional fees
          Breast pumps                                                                 Massage therapy
          Classes, health-related                                                      Naturopathic healers
          Counseling                                                                   Nutritionist’s professional expenses
          Diabetic socks                                                               Occupational therapy
          Dietary supplements                                                          Supplements
          Doula                                                                        Ultrasound, prenatal
          Ear plugs                                                                    Umbilical cord blood storage
          Fertility treatments                                                         Varicose veins, treatment of
          Genetic testing                                                              Vitamins
          Health club fees                                                             Wigs

                  Categories of Product that now require a Doctor’s Prescription for FSA
                                     Reimbursement after 12/31/10

The new rule takes effect January 1, 2011 and applies to purchases on or after January 1, 2011, regardless of plan year. If a plan year started
on September 1, 2010, participants can be reimbursed for an OTC drug without a prescription if it was purchased before January 1, 2011. On or
after that date, participants will be required to have a prescription for reimbursement of these items.

The only acceptable form of documentation for reimbursement for OTC drugs and medicines is a doctor's prescription, as regulated by state law.
A letter of medical necessity will not be acceptable.

          Acid Controllers                                                             Feminine Anti-Fungal/Anti-Itch
          Allergy medicine                                                             Hemorrhoidal Preps
          Antibiotics                                                                  Laxatives
          Anti-Diarrheals                                                              Motion Sickness
          Anti-Gas Products                                                            Pain Relievers
          Anti-Itch & Insect Bite                                                      Respiratory Treatments
          Anti-Parasitic Treatments                                                    Rubbing alcohol
          Baby Rash Ointments/Creams                                                   Sinus medicine
          Cold Sore Remedies                                                           Sleep Aids & Sedatives
          Cough, Cold & Flu                                                            Stomach Remedies
          Digestive Aids
If you are not sure whether an item is eligible for FSA reimbursement, please contact the Stirling Benefits Flexible
Spending Unit at 800-447-6689.

                                  Stirling Benefits, Inc. | 20 Armory Lane | Milford, CT 06460
                                            1.800.447.6689 |

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