HEALTH CARE ACCOUNT - WHAT’S ELIGIBLE See IRS Publication 502 For More Information. Examples of Eligible Expenses for 2012 Note: If you simultaneously participate in a Medical Health Savings Account (HSA), you may use your Health Care Flexible Spending Account only for eligible dental and vision expenses. To qualify for reimbursement, health care expenses not covered by your medical and dental plan must be considered expenses for medical care under Section 105(b) or 213(d)(1) of the Internal Revenue Code. Examples include: Deductibles and copayments under your medical and dental plan or other medical and dental plan covering your eligible dependents, such as: Hospital deductible and copayment Physician visit copayment Prescription drug copayment Durable medical equipment, including diabetic test strips and syringes Dental copayments for restorative care or orthodontia or dental implants Expenses not paid by your medical and dental plan or by any other medical or dental plan covering your eligible dependents, such as: Prescription eyeglasses, contact lenses, and laser eye surgery Hearing care, including hearing aids and tests not reimbursed by your medical plan Services and prescription drugs for infertility treatment Uncovered health care services obtained outside of the provider network Mental health copayments and services over medical limits Smoking cessation drugs prescribed by a physician Weight-loss programs related to hypertension, diabetes, or other medical conditions Expenses in excess of medical or dental plan limits (e.g., orthodontic expenses greater than the limit set by your dental plan) Eye care supplies (e.g., contact lens cleaning, saline solutions) Charges for certain other medical services that would qualify as tax deductible medical expenses under IRS rules (Note: not all expense items listed in IRS Publication 502 are reimbursable expenses under a Health Care Flexible Spending Account) Certain over-the-counter (OTC) items such as those listed below that are purchased for treatment of a specific medical condition. Note: all reimbursable OTC expenses may only be reimbursed in reasonable quantities, such as one- to two-month supplies. Adult incontinence products (e.g., Depends) Breast pumps/lactation supplies Contact lens solution/eye drops Contraceptives and birth control products Ear supplies (e.g., ear plugs) First aid supplies Hand sanitizer Health monitors (e.g., blood pressure, cholesterol, HIV, thermometers) Hearing aid batteries Heat wraps (e.g., ThermaCare) Heating pads/hot water bottles Insulin and diabetic supplies Pregnancy tests/ovulation kits Sunscreen (SPF 30 and greater) Supports/braces (e.g., ankle, knee, wrist, therapeutic glove) Certain over-the-counter (OTC) expenses such as those listed below if additional substantiation of a prescription is provided. This includes a medical provider's written prescription stating: patient's name, name of medicine/drug, diagnosis or medical condition warranting the medication, dosage requirements, and signature of medical provider. Acne treatments/medications Joint treatment (e.g., Glucosamine) Allergy and sinus medications (e.g., Benadryl, Claritin, Sudafed) Lactose intolerant pills Anti-fungal medications (e.g., Lotramin AF) Motion sickness pills Anti-itch medications (e.g., Caladryl, Cortizone) Nasal sprays for congestion (e.g., Afrin) Antiperspirants Nicotine patches/gum/lozenges Cold sore medications Orthopedic inserts/shoes Cough, cold, and flu remedies Pain relievers (e.g., aspirin, Excedrin, Tylenol, Advil, Motrin) Decongestants Sleeping aids Dietary supplements (e.g., certain vitamins, minerals) St. John's Wort Fiber supplements Suppositories First aid creams Toothache relievers (e.g., Oragel) Gastrointestinal aids (e.g., antacids, anti-diarrhea medicines, non-fiber laxatives, nausea medication) Topical ointments Herbal medicines Weight-loss drugs Hormone therapy Yeast infection creams (e.g., Monistat) Wart remover medications HEALTH CARE ACCOUNT - WHAT’S NOT ELIGIBLE Any expense that may be reimbursed from another source, such as insurance Certain over-the-counter expenses, such as those listed below: Blemish concealer Insect repellant Cosmetics/facial creams Lip balms (e.g., ChapStick®) Dental care products (e.g., dental floss, toothpaste/brushes, cleaning systems) Medicated shampoos Deodorant Depilatories Dietary food or drink products Feminine hygiene products Hair growth treatments Moisturizers/skin lotions Most vitamin and minerals Mouthwash/fluoride rinse Soaps/toiletries Suntan lotions Teeth-whitening products Cosmetic surgery or treatment, such as a facelift, liposuction, hair transplants, electrolysis, collagen injections, botox injections Dental procedures done solely for cosmetic reasons, such as bleaching, bonding, laminates, or veneers Drugs, such as Renova, Retin-A, Minoxidril, Propecia, or Rogaine, used solely for cosmetic reasons Employment or flight physicals Expenditures that are merely beneficial or educational for your general health Expenses incurred during prior plan years Expenses that are incurred after your termination date unless you elect to prefund your account or continue through COBRA Expenses that are incurred before your effective date Eyewear service agreement or insurance unless it includes a check-up Finance charges, late fees, gratuities, or charges for failed/missed appointments Health club dues, YMCA/YWCA dues, or charges for steam baths or massages for your general health or to relieve physical or mental discomfort Massage therapy unless prescribed by a physician for a specific medical condition Non-prescription eyeglasses (frames only), sunglasses, clip-ons, and contact lenses Over-the-counter (OTC) expenses not substantiated with the required prescription Premiums for long-term care coverage Premium payments for any insurance or HMO contract, such as the insurance premium paid for an individual policy or for the group insurance/HMO premium for you or your eligible dependents even if the premium was paid with after-tax dollars Prescription drugs purchased outside the U.S. Weight-loss programs for your general health even when prescribed by a physician