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Cafeteria Plan - Example of Expenses

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  • pg 1
									     EXAMPLES OF NON-ELIGIBLE MEDICAL EXPENSES

X   Body Piercing                                      X   Illegal Operations and Treatments
X   Breast Pump                                        X   Insurance Premiums
X   Chauffeur Services                                 X   Liposuction
X   Controlled Substances                              X   Long-term care services.
X   Cosmetic Surgery directed only at improving        X   Maternity Clothes
    appearance
                                                       X   Medical Savings Accounts
X   Cosmetic Products
                                                       X   Personal hygiene products
X   Dancing Lessons
                                                       X   Personal Items
X   Diapers for Infants
                                                       X   Preferred Provider Discounts
X   Diaper Service
                                                       X   Salary expense of a nurse to care for a healthy
X   Ear Piercing                                           newborn at home
X   Electrolysis                                       X   Swimming Lessons
X   Fees written off by provider                       X   Tattoos/Tattoo Removal
X   Food supplements                                   X   Teeth Whitening
X   Funeral Expenses                                   X   Transportation expenses to and from work
X   Hair Transplant                                    X   Trip or vacation taken for well being
X   Herbs                                              X   Uniforms
X   Household and Domestic Help                        X   Vitamins without Prescription




                                                        This list is non-inclusive. It is not to represent all
                                                        allowable or non-allowable charges. You may
                                                        refer any further questions regarding allowable
                                                        & non-allowable charges to your service provider.




Phone: 501-687-6954                                                                       Fax: 501-687-3282
                                         Email: info@idpas.com
           EXAMPLES OF ELIGIBLE MEDICAL EXPENSES
   Adoption - Medical Expense (incurred before                   Medicines (If prescribed by physician and if only
    adoption is finalized)                                         available by prescription.)
   Alcoholism Treatment                                          Occlusal Guards (to prevent teeth grinding)
   Ambulance                                                     Operations (Legal)
   Artificial Limbs                                              Optometrist
   Artificial Teeth                                              Orthodontia (unless for cosmetic purposes)
   Braille Books/Magazine (difference between                    Osteopath
    regular material and Braille materials)
                                                                  Over-the-Counter drugs (To treat a medical
   Car Controls for Handicapped                                   Condition) (Advil, Tylenol, Aspirin, Band aids)
   Chiropractic Services                                         Oxygen
   Christian Science Practitioners (payments for                 Peridontal Fees
    medical care)
                                                                  Physical Exams (except for employment-related
   Coinsurance Amounts and Deductibles                            physicals)
   Contact Lenses and Solution                                   Physical Therapy (for specified medical purpose)
   Crutches & Bandages                                           Prescription Sunglasses
   Dental Treatment                                              Private Hospital Room
   Diagnostic Tests                                              Psychiatric Care
   Drug Addiction Treatment                                      Psychoanalysis
   Eye Examinations and Eyeglasses                               Radial Keratotomy
   Guide dog or Other Animal (purchase, training,                Surgery
    and care of animal)
                                                                  Telephone for the Deaf
   Hearing Aids and Examinations
                                                                  Transplants
   Hospital Services
                                                                  Transportation for Seminar on Medical
   Injections                                                     Condition
   Insulin                                                       Cost of Seminar on Medical Condition
   Laboratory Fees                                               Vaccinations
   Lasik Eye Surgery                                             X-Rays
   Learning Disabled Child:
    Special School/Teacher                                      This list is non-inclusive. It is not to represent all
                                                                allowable or non-allowable charges. You may
   Medical Monitoring and Testing Devices (if                  refer any further questions regarding allowable
    prescribed by physician for a particular ailment).          & non-allowable charges to your service provider.


Phone: 501-687-6954                                                                          Fax: 501-687-3282
                                           Email: info@idpas.com

								
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