HM Medical Clinic

 

Microsoft word - 04-medical care reimbursement packet.doc

MEDICAL CARE REIMBURSEMENT ACCOUNT
Partial ELIGIBLE Medical Expense List
PARTIAL ELIGIBLE MEDICAL CARE EXPENSE LIST
ELIGIBILITY FOR
(REIMBURSABLE UNDER THE MEDICAL CARE FSA)
Abortions, legal abortions only
ELIGIBLE
ELIGIBLE
Adoption, i.e. medical expenses for the child incurred before adoption is finalized ELIGIBLE
ELIGIBLE
Artificial Limbs ELIGIBLE
Artificial Teeth ELIGIBLE
Birth Control Devices
ELIGIBLE
Body Scan, Full (see also Vital Imaging) ELIGIBLE
ELIGIBLE
Breast Pumps, by prescription for a specific medical condition ELIGIBLE
Braille, books and magazines ELIGIBLE
Child Birth (see also Lamaze)
ELIGIBLE
ELIGIBLE
Christian Science Practitioners (for medical care only) ELIGIBLE
Contact Lenses (including contact lens solutions) ELIGIBLE
Confinement, costs for physical or mental illness confinement ELIGIBLE
Co-payments, see "Insurance co-payments" ELIGIBLE
ELIGIBLE
Deaf Communication Equipment, special equipment
ELIGIBLE
ELIGIBLE
ELIGIBLE
ELIGIBLE
ELIGIBLE
ELIGIBLE
Domestic Partner's Medical Expenses (If legal dependent, per Internal Revenue Code 152) ELIGIBLE
Drug and Alcoholism, testing and treatment ELIGIBLE
Drug and Medical Supplies ELIGIBLE
Earplugs, if prescribed for a specific medical condition
ELIGIBLE
Eyeglasses, including examination fees ELIGIBLE
Fertility Treatments
ELIGIBLE
Guide Dog
ELIGIBLE
Handicap Schooling, i.e. tuition fees at special school for handicapped
ELIGIBLE
Hearing Devices and Batteries ELIGIBLE
Hormone Replacement Therapy, such as Premarin ELIGIBLE
Hospital Services, including private hospital rooms ELIGIBLE
ELIGIBLE
Insurance Co-Payments; not including insurance premiums unless specifically elected by your ELIGIBLE
Employer
Laboratory Fees
ELIGIBLE
Lamaze Classes, expenses for mothers only ELIGIBLE
Laser Vision Correction ELIGIBLE
Learning Disabilities, fees for specialty schools and specially trained teachers if recommended by a ELIGIBLE
physician
Massage Therapy, if prescribed by a physician for a specific illness or injury
ELIGIBLE
MEDICAL CARE REIMBURSEMENT ACCOUNT
Partial ELIGIBLE Medical Care Expense List
PARTIAL ELIGIBLE MEDICAL CARE EXPENSE LIST (Continued)
ELIGIBILITY FOR
(REIMBURSABLE UNDER THE MEDICAL CARE FSA)
Meals and Lodging at a hospital or similar institution when receiving inpatient medical care ELIGIBLE
Mental Illness, Legal fees to authorize treatment of a mental illness ELIGIBLE
Mentally / Physically Handicapped Dependent Expenses ELIGIBLE
Mileage, to and from Physician's office ELIGIBLE
Norplant removal
ELIGIBLE
Nurse's Fees, such as licensed practical nurse fees ELIGIBLE
Obstetrical Expenses
ELIGIBLE
Operations/Surgeries ELIGIBLE
ELIGIBLE
Organ Transplant, recipient may also claim donor expenses ELIGIBLE
ELIGIBLE
Orthopedic Shoes ELIGIBLE
ELIGIBLE
Over-the-Counter Drugs, as defined by IRS Code Section 213 ELIGIBLE
ELIGIBLE
Physical Exams, including routine physicals
ELIGIBLE
Physical Therapy ELIGIBLE
ELIGIBLE
Pre-existing Conditions ELIGIBLE
Pregnancy Home Testing Kits (i.e. over-the-counter products) ELIGIBLE
Psychiatric Care, if medically necessary only* ELIGIBLE
Psychologist Fees, if medically necessary only* ELIGIBLE
Radial Keratotomy
ELIGIBLE
Smoking Cessation Programs, physician directed only
ELIGIBLE
ELIGIBLE
Vaccines
ELIGIBLE
ELIGIBLE
Vital Imaging (see also Body Scan, Full) ELIGIBLE
Vitamins, only eligible if filled by a Pharmacist ELIGIBLE
Weight loss medications, prescribed by a physician, such as Meridia
ELIGIBLE
ELIGIBLE
Wigs, used to cover hair loss due to illness or disease ELIGIBLE
ELIGIBLE
*A letter from the service provider must be submitted, along with the reimbursement request, stating that these services are medically necessary. Without this confirmation, reimbursements will be denied and notification will be mailed or e-mailed to you requesting re-submittal or stating reason for ineligibility. FLEXIBLE SPENDING ACCOUNTS
Partial INELIGIBLE Medical Expense List
PARTIAL INELIGIBLE MEDICAL CARE EXPENSE LIST
ELIGIBILITY FOR
(NOT REIMBURSABLE UNDER THE MEDICAL CARE FSA)
Automobile Insurance Premiums, including the segment of premiums providing medical coverage
INELIGIBLE
for persons injured in an auto accident
Blood Pressure Monitors
INELIGIBLE
Cosmetic Procedures
INELIGIBLE
Counseling, for marriage or family issues, unless specified as medically necessary by the service INELIGIBLE
provider
Dental Procedures, cosmetic, i.e. teeth bleaching
INELIGIBLE
Exercise Equipment, not prescribed by a physician for a specific disease or ailment
INELIGIBLE
Eyeglasses for Sports, unless specific prescription is provided INELIGIBLE
Funeral & Burial Expenses
INELIGIBLE
Health Club Services/Fees - unless related to a specific medical condition
INELIGIBLE
INELIGIBLE
Homeopathic/Holistic Medicine including, herbs and natural medication; naturopathic INELIGIBLE
services/remedies Hair Loss Remedies including Propecia and Rogaine INELIGIBLE
Household and Domestic Help, even if recommended by a qualified physician due to an employee's or INELIGIBLE
dependent's inability to perform physical housework
Institutional care, including custodial care in an institution
INELIGIBLE
Insurance Premiums, i.e. monies paid for insurance policies that are not sponsored by your INELIGIBLE
employer
Liposuction
INELIGIBLE
Massage Therapy, unless prescribed by physician for specific illness or injury
INELIGIBLE
Maternity items including maternity clothes, diaper service, etc. INELIGIBLE
Medical/Dental Services Rendered by a Relative INELIGIBLE
Nurse Fees, including the salary of a licensed practical nurse incurred in connection with the care
INELIGIBLE
of a normal and healthy newborn (even though such expenses may be required)
Operations/Surgeries, illegal and/or cosmetic. Any expense incurred in connection with an illegal
INELIGIBLE
operation or treatment or for cosmetic reasons Over-the-counter products for general health and well-being INELIGIBLE
Personal Hygiene items such as cosmetics, toiletries, toothpaste, etc.
INELIGIBLE
Prescription Drug Discount Programs where actual medical treatment is not received INELIGIBLE
Receipts, such as charge card carbon copies, other charge card receipts, or balance due
INELIGIBLE
statements for expenses incurred are not acceptable reimbursement receipts
Special Schools, i.e. costs for sending a child to a special school for anticipated benefits the child
INELIGIBLE
may receive from the course of study and the disciplinary methods Social Activities such as dance lessons, swimming lessons, or classes (even if recommended by a INELIGIBLE
qualified physician for general health improvement) Supplements (nutritional and for general health) INELIGIBLE
Teeth Bleaching
INELIGIBLE
Uniforms
INELIGIBLE
Vision Insurance Premiums or discount programs
INELIGIBLE
Vitamins taken for general health purposes INELIGIBLE
Water, bottled
INELIGIBLE
Weight Loss Programs for your general health (including food and drugs) even if prescribed by a INELIGIBLE

Source: https://www.goigoe.com/flex/pdf/Medical%20Care%20Reimbursement1.pdf