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Flexible Spending Account


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									                                                  Flexible Spending Account
                                                     IRS Eligible Expenses

                                                    Eligible Medical Expenses
              Birth control pills                Hospitalization costs                       Physical exams for adults and
              Chiropractic therapy               Hypnosis for treatment of an                 children
              Contact lenses                      illness                                     Physical therapy
              Co-pays                            Immunizations                               Physician services
              Crutches                           Individual therapy                          Prescription drugs
              Deductibles                        Laboratory fees                             Psychoanalysis and mental health
              Dental care                        Lasik eye surgery                            therapy
              Diabetic Supplies                  Massage therapy                             Vision care
              Eye exams & Glasses                Non-prescription drugs used to              Weight loss programs when
              Group therapy                       treat a current medical                      specifically recommended by a
              Hearing aids &                      condition                                    physician to treat obesity or
               batteries                          Orthodontia                                  another medical condition
              Hearing care                       Orthotics                                   Wheelchairs

 Over-the-Counter Drugs* (Effective 1/1/2011)

 As part of the federal Patient Protection and Affordable Care Act, previously eligible over-the-counter drugs, such as
 Tylenol® and Prilosec®, can no longer be paid with the Benefit Strategies HCSA debit cards. A prescription or physician
 statement will be required. For reimbursement, submit a claim form with the prescription. For a complete list of eligible
 over-the-counter drugs, see the participant handbook.

                                          Eligible Dependent Care Expenses
                                                                                           Ineligible Expenses Include:
        Child care (at daycare                   Adult daycare expenses                       Education and tuition fees
         center, day camp, nursery                Expenses for a housekeeper whose             Late payment fees
         school or by a private sitter)            duties include caring for an eligible        Overnight camps (in general)
        Late pick-up fees (from a                 dependent                                    Sports lessons, field trips, clothing
         caregiver)                               Placement fee expenses for hiring            Your cost of transportation to and
        Before and after-school care              an au pair, as well as his/her                from a dependent care provider
         (must be billed separate from             weekly stipend
         tuition expenses)

                                                   Ineligible Medical Expenses
            Aromatherapy                                                 Hair re-growth systems
            Couples/Family Therapy                                       Insurance Premiums
            Cosmetic Surgery                                             Skin care
            Chap stick                                                   Teeth bleaching
            Deodorants                                                   Tooth brush/paste
            Feminine Care                                                Weight loss programs for general well-being

*Please note that there are a few select items that will not be deemed acceptable when using your Benefit
Strategies HCSA debit card. Please pay for these items using other means and submit a claim to our office with
a prescription for further review. Plan restrictions may apply. Check your plan handbook for details.

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