Health Savings Account HSA Qualified Medical Expenses

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					 Health Savings Account (HSA)
 Qualified Medical Expenses
 This is a quick reference list of products and services that can be reimbursed from a health savings account (HSA).
 (These expenses are only reimburseable to the extent that no insurance benefits were paid). It is provided as
 reference only and is not meant to be comprehensive. For more detailed information, please refer to IRS Publication
 502 or contact your HSA administrator. To order IRS Publication 502, call 1.800.TAXFORM or visit their website
 at For tax advice, please seek the services of a competent tax professional.

 HSA-Eligible Healthcare Expenses

 Eligible healthcare expenses may include, but are not limited to:

   m Acupuncture                                                m Hospital services (including meals and lodging)
   m Alcoholism treatment                                       m Insulin
   m Ambulance services                                         m Laboratory fees
   m Artificial limb or prosthesis                              m Lactation assistance supplies
   m Artificial teeth                                           m Long-Term Care insurance (Qualified contracts;
   m Birth control pills                                          subject to additional limitations)

   m Braille books/magazines (portion of costs)                 m Medicines or drugs (including Over-the-Counter
                                                                  medicines with a doctor’s prescription)
   m Car adaptations (for a person with a disability)
                                                                m Nursing home
   m Chiropractors
                                                                m Nursing services
   m Christian science practitioners
                                                                m Operations or surgery
   m Contact lenses (including saline solution and cleaner)
                                                                m Psychiatric care
   m Crutches
                                                                m Psychologist
   m Dental treatment (x-rays, fillings, extractions, etc.)
                                                                m Telephone equipment (for vision/hearing-impaired)
   m Diagnostic devices (such as a blood sugar test kit)
                                                                m Television equipment (for hearing-impaired)
   m Doctor’s fees
                                                                m Therapy or counseling
   m Drug addiction treatment
                                                                m Transplants
   m Eyeglasses (including eye examinations)
                                                                m Transportation for medical care
   m Eye surgery (including laser eye surgery)
                                                                m Vasectomy
   m Fertility enhancement (including in-vitro fertilization)
                                                                m Wheelchair
   m Guide dog (for visually-impaired or hearing-impaired)
                                                                m X-Rays
   m Hearing aids and hearing aid batteries

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 Examples of Eligible Over-the-Counter Expenses
 (Over-the-Counter Medicines with Doctor’s prescription only)

   m Allergy medicine                                            m Laxatives
   m Antacids                                                    m Motion sickness pills
   m Bandages & gauze                                            m Nasal spray
   m Bug bite medication                                         m Nicotine gum or patches
   m Carpal tunnel wrist support                                 m Pain relievers
   m Cold & flu medicine                                         m Pregnancy test kit
   m Cold/hot packs for injuries                                 m Reading glasses
   m Condoms & spermicides                                       m Sinus medication
   m Contact lens solution                                       m Sunburn ointment
   m Cough drops and throat lozenges                             m Suppositories
   m First aid kits                                              m Thermometer
   m First aid ointment

 Examples of Non-Eligible Over-the-Counter Expenses
   m Cosmetics (including face creams and moisturizers)          m Suntan lotion
   m Deodorant                                                   m Tampons
   m Fiber supplements                                           m Tissues
   m Lip balm (including ChapStick ) ®                           m Toiletries (including toothpaste)
   m Medicated shampoo and soaps                                 m Vaseline
   m Multivitamins                                               m Weight scales
   m Over-the-Counter medicines without
      a doctor’s prescription

 Examples of Expenses That Do Not Qualify for Reimbursement Through an HSA
   m Babysitting, childcare and nursing services for             m Household help
      a normal, healthy baby                                     m Illegal operations and treatments
   m Controlled substances obtained in violation                 m Insurance premiums
      of federal law                                             m Maternity clothes
   m Cosmetic surgery
                                                                 m Personal use items
   m Dancing lessons
                                                                 m Swimming lessons
   m Diaper service
                                                                 m Teeth whitening
   m Electrolysis or hair removal
                                                                 m Vacation or travel
   m Funeral expenses
                                                                 m Veterinary fees
   m Hair transplant
                                                                 m Weight loss programs for improvement of
   m Health club dues                                               appearance, general health or sense of well-being

 AVMA GHLIT, New York Life Insurance Company and HealthPlan Services bear no responsibility for the
 establishment or administration of any HSA, so please consult your tax advisor.                                                                                      1.800.621.6360
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