Eligible Health Care FSA (HC FSA) Expenses

Various Eligible Expenses

You can use your Health Care FSA (HC FSA) funds to pay for a wide variety of health care products and services for you, your spouse, and your dependents. The IRS determines which expenses can be reimbursed by an FSA.

Keep Your Receipts

Please save your receipts and other supporting documentation related to your HC FSA expenses and claims. The IRS may request itemized receipts to verify the eligibility of your expenses. Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.

Displaying expenses 1-320 of 320

Eligible?	Additional Document	Expense
Eligible with a detailed receipt		Acne treatments (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Activity Tracker
Eligible with a detailed receipt		Acupuncture
Eligible with a detailed receipt		Adoption (medical expenses related to)
Not eligible		Adoption fees
Eligible with a detailed receipt		Alcoholism treatment
Eligible with a detailed receipt		Allergy & sinus medicine (over-the counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Allergy treatments products (HEPA filters, Air purifier, etc.)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Alternative drugs, medicines and treatment products (for treatment of a medical condition)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Alternative healers (for treatment of a medical condition, when rendered by a licensed, certified, and/or registered health care provider)
Eligible with a detailed receipt		Ambulance and emergency health services
Eligible with a detailed receipt		Anesthesia (for non-cosmetic purposes)
Eligible with a detailed receipt		Antacid (over-the-counter)
Eligible with a detailed receipt		Antibiotic ointment (over-the-counter)
Eligible with a detailed receipt		Aspirin or other pain reliever (over-the-counter)
Eligible with a detailed receipt		Asthma medicines or treatments (over-the-counter)
Eligible with a detailed receipt		Athletic treatments / braces
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Baby (special) formula (Only cost difference between special and regular formula, plus documentation of cost difference required)
Eligible with a detailed receipt		Bandages and related items (over-the-counter)
Eligible with a detailed receipt		Birth control (over the counter)
Eligible with a detailed receipt		Birth control (prescription)
Eligible with a detailed receipt		Blood pressure monitor
Eligible with a detailed receipt		Body scans
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Botox (for treatment of a medical condition)
Eligible with a detailed receipt		Braille books and magazines (Only cost difference between standard media and braille media, plus documentation of cost difference required)
Eligible with a detailed receipt		Breast pump
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Breast reconstruction surgery (following mastectomy)
Eligible with a detailed receipt		Breastfeeding classes
Eligible with a detailed receipt		Canker & cold sore treatments (over-the-counter)
Not eligible		Cannabidiol (CBD) Products
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Car modifications (as required for a medical condition diagnosed by a licensed health care professional)
Eligible with a detailed receipt		Chest rubs (over-the-counter)
Not eligible		Child or newborn care instruction
Eligible with a detailed receipt		Childbirth classes (charges for mother only)
Eligible with a detailed receipt		Chiropractic care
Eligible with a detailed receipt		Cholesterol test kits and supplies
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Christian Science practitioners
Eligible with a detailed receipt		Cold & flu medicine (over-the-counter)
Eligible with a detailed receipt		Colon hydrotherapy
Eligible with a detailed receipt		Colonoscopy preparation kit (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Compression or anti-embolism socks, stockings or hose (10-20 mmHg)
Eligible with a detailed receipt		Compression or anti-embolism socks, stockings or hose (20-30 mmHg or 30-40 mmHg)
Eligible with a detailed receipt		Concierge medical fees (billed for actual services received)
Not eligible		Concierge medical fees (billed for future availability of services, with no services actually received)
Eligible with a detailed receipt		Condoms
Eligible with a detailed receipt		Contact lenses and solutions
Eligible with a detailed receipt		Contraceptives (over-the-counter)
Eligible with a detailed receipt		Co-payment (medical, in-network)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Cord blood storage (for future treatment of a birth defect or known medical condition)
Not eligible		Cord blood storage (for unidentified future use)
Eligible with a detailed receipt		Corn and callus remover (over-the-counter)
Eligible with a detailed receipt		Corneal keratotomy
Not eligible		Cosmetic procedures or surgery
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Cosmetic procedures or surgery for birth defects, accidents, and/or disease
Eligible with a detailed receipt		Cough drops & sore throat lozenges (over-the-counter)
Eligible with a detailed receipt		Cough syrup (over-the-counter)
Eligible with a detailed receipt		Counseling (for treatment of a medical condition)
Not eligible		Counseling (marriage)
Eligible with a detailed receipt		COVID Testing
Eligible with a detailed receipt		COVID testing (over-the-counter)
Eligible with a detailed receipt		CPAP and Supplies
Not eligible		CPR classes (adult or child)
Eligible with a detailed receipt		Crutches, canes, walkers or like equipment (purchase or rental)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Cryotherapy - Cold Therapy (for treatment of medical condition)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Dancing lessons (for treatment of a medical condition)
Eligible with a detailed receipt		Defibrillator
Eligible with a detailed receipt		Dental
Eligible with a detailed receipt		Dental Sealants
Eligible with a detailed receipt		Dental (Co-insurance, Co-Payment and Deductible)
Eligible with a detailed receipt		Dental (for non-cosmetic purposes)
Eligible with a detailed receipt		Dental Bridge
Eligible with a detailed receipt		Dental Denture
Eligible with a detailed receipt		Dental Implants
Not eligible		Dental products for general health
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Dental veneers
Eligible with a detailed receipt		Denture Adhesive (Fixodent)
Eligible with a detailed receipt		Denture Cleaner (Efferdent)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Dermatology treatments
Eligible with a detailed receipt		Diabetic monitors, test kits, strips and supplies
Eligible with a detailed receipt		Diagnostic services (other than dental or vision)
Eligible with a detailed receipt		Diaper rash ointments and creams
Not eligible		Diapers and diaper services
Not eligible		Doula (emotional support, parenting information, childcare, and housekeeping)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Doula (itemized medical care only, from a certified provider)
Eligible with a detailed receipt		Drug addiction treatment
Not eligible		Drugs (imported)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Dual-purpose product (Only cost difference between special and regular product, plus documentation of cost difference required)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Dyslexia treatment
Eligible with a detailed receipt		Ear drops & wax removal (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Ear plugs
Not eligible		Educational classes or tuition
Not eligible		Electrolysis
Eligible with a detailed receipt		Emergency (medical) kits
Not eligible		Emergency (non-medical)/disaster survival kits
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Ergonomic home office furniture and accessories (for treatment of a medical condition)
Not eligible		Exceed Plan Maximum
Not eligible		Excessive Mileage
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Exercise equipment or program (as treatment for a medical condition)
Eligible with a detailed receipt		Eye drops and treatments (over-the-counter)
Eligible with a detailed receipt		Eye examinations
Eligible with a detailed receipt		Eyeglasses (prescription)
Not eligible		Face lifts
Not eligible		Feminine hygiene care (Deodorants, General Cleansing products, Feminine spray)
Eligible with a detailed receipt		Fertility monitor (over-the-counter)
Eligible with a detailed receipt		Fertility treatment (for employee, spouse or dependent)
Not eligible		Fertility treatment (for non-dependent surrogate)
Not eligible		Finance Charges
Eligible with a detailed receipt		First aid kits (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Fitness programs (as treatment for a medical condition diagnosed by a licensed health care professional)
Eligible with a detailed receipt		Flu shots
Not eligible		Funeral expenses
Eligible with a detailed receipt		Gastrointestinal medication (over-the-counter)
Eligible with a detailed receipt		Genetic Counseling (for a medical condition)
Eligible with a detailed receipt		Glucosamine and Chondroitin
Not eligible		Gluten Free Products
Eligible with a detailed receipt		Hair Growth Medication over-the-counter (i.e. Rogaine)
Not eligible		Hair regrowth products
Not eligible		Hair removal
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Hair supplements (eligible with LMN)
Not eligible		Hair transplant
Not eligible		Hand lotion (over-the-counter)
Eligible with a detailed receipt		Hand Sanitizer
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	HCG Injections
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Health club dues (as treatment for a medical condition diagnosed by a licensed health care professional)
Eligible with a detailed receipt		Hearing aids and batteries (OTC or prescribed)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Herbal or homeopathic medicines (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Home improvements (as required for a medical condition diagnosed by a licensed health care professional)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Hormone Replacement or Pellet Therapy (for treatment of a medical condition)
Eligible with a detailed receipt		Hospital fees
Eligible with a detailed receipt		Hospital services and fees
Not eligible		Household help
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Humidifier, vaporizer, filter and supplies
Not eligible		Hygiene Products (toothbrush, lotion, soap, etc.)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Hypnosis
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Hypoallergenic Encasement products (Only cost difference between special and regular encasement product, plus documentation of cost difference required)
Not eligible		Illegal operations or substances
Eligible with a detailed receipt		Immunizations
Eligible with a detailed receipt		Incontinence (adult) Supplies (e.g., depends)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Incontinence (children) Supplies (e.g., diapers) (for treatment of a medical condition)
Eligible with a detailed receipt		Infertility treatment (for employee, spouse or dependent)
Not eligible		Insect Repellant
Eligible with a detailed receipt		Insulin, testing materials and supplies
Not eligible		Insurance Payment/Adjustment
Not eligible		Insurance Premiums
Eligible with a detailed receipt		Invisalign and other clear dental aligners (including self-service mail order)
Eligible with a detailed receipt		Lab (medical)
Eligible with a detailed receipt		Laboratory fees
Eligible with a detailed receipt		Lactation Supplies: creams/ointment, pad/shields, storage bags/bottles
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Lactose intolerance supplements (Over the Counter)
Eligible with a detailed receipt		Lamaze classes (charges for mother only)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Laser Treatment
Eligible with a detailed receipt		Lasik
Not eligible		Late payment fees charged by health care provider
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Latex Gloves
Eligible with a detailed receipt		Laxatives (over-the-counter)
Eligible with a detailed receipt		Learning disability treatments
Eligible with a detailed receipt		Lice treatment
Eligible with a detailed receipt		Listening therapy
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Lodging (limited to $50 per night for patient to receive dental or vision care and $50 per night for one caregiver)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Lodging (limited to $50 per night for patient to receive medical care and $50 per night for one caregiver)
Not eligible		Long term care services
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Magnetic therapy (over-the-counter)
Eligible with a detailed receipt		Masks
Not eligible		Massage Memberships Dues
Eligible with a detailed receipt		Massage therapy
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Massager guns/devices (as a treatment for a medical condition)
Eligible with a detailed receipt		Mastectomy-related special bras
Not eligible		Maternity clothes
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Mattresses - Once every 10 yrs up to $800 max
Eligible with a detailed receipt		Medical (Co-insurance, Co-Payment, Deductible)
Eligible with a detailed receipt		Medical abortion
Eligible with a detailed receipt		Medical equipment (for treatment of medical condition) and repairs
Not eligible		Medical literature, books, pamphlets or audio
Not eligible		Medical Marijuana (Not eligible)
Eligible with a detailed receipt		Medical monitoring and testing devices
Eligible with a detailed receipt		Medical records charges
Eligible with a detailed receipt		Medical supplies (for treatment of a medical condition)
Eligible with a detailed receipt		Medicines (over-the-counter)
Eligible with a detailed receipt		Menstrual care products (Liners, Pads, Tampons, Cups, Menstrual undergarments)
Eligible with a detailed receipt		Midwife
Not eligible		Mileage (for travel to / from anything other than eligible care)
Eligible with a detailed receipt		Mileage (for travel to/from eligible dental care)
Eligible with a detailed receipt		Mileage (for travel to/from eligible health care)
Eligible with a detailed receipt		Mileage (for travel to/from eligible vision care)
Not eligible		Misc. Personal Use Items
Not eligible		Missed Appointment Fee
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Modified equipment (Only cost difference between special and regular equipment, plus documentation of cost difference required)
Eligible with a detailed receipt		Monitors & test kits (over-the-counter)
Eligible with a detailed receipt		Motion & nausea (Over-the-Counter)
Eligible with a detailed receipt		Nasal Spray (Medicated) (Over-the-Counter)
Eligible with a detailed receipt		Nasal Spray (Saline Solution) (Over-the-Counter)
Eligible with a detailed receipt		Nasal strips (over-the-counter)
Eligible with a detailed receipt		Neti Pot
Eligible with a detailed receipt		Non-prescription drugs and medicines (for non-cosmetic purposes)
Eligible with a detailed receipt		Norplant insertion or removal
Not eligible		Nursing Home Care
Eligible with a detailed receipt		Nursing services (wages and taxes)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Nutritional Counseling
Eligible with a detailed receipt		OB/GYN fees
Eligible with a detailed receipt		Occlusal guards to prevent teeth grinding
Eligible with a detailed receipt		Occupational therapy (related to a medical condition or disability)
Eligible with a detailed receipt		Office visit (medical)
Eligible with a detailed receipt		Office visits (vision)
Eligible with a detailed receipt		Operations (for non-cosmetic purposes)
Eligible with a detailed receipt		Optometrist / ophthalmologist fees
Not eligible		Oral care (over-the-counter)
Eligible with a detailed receipt		Organ transplants (recipient and donor)
Eligible with a detailed receipt		Ortho keratotomy
Eligible with a detailed receipt		Orthodontia
Eligible with a detailed receipt		Orthodontia (braces and retainers)
Eligible with a detailed receipt		Orthopedic & surgical supports
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Orthopedic shoes (Only cost difference between RX orthopedic shoe and non-specialized shoe, plus documentation of cost difference required)
Eligible with a detailed receipt		Orthotics/Orthopedic Inserts
Eligible with a detailed receipt		Over-the-counter (drugs and medicines)
Not eligible		Over-the-Counter medication (2019 Requires Prescription from your doctor)
Eligible with a detailed receipt		Over-the-Counter Product (for treatment of medical condition)
Eligible with a detailed receipt		Ovulation monitor (over-the-counter)
Eligible with a detailed receipt		Oxygen
Eligible with a detailed receipt		Pain reliever (over-the-counter)
Eligible with a detailed receipt		Payment Processing Fees
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Phototherapy - Light Therapy (for treatment of medical condition)
Eligible with a detailed receipt		Physical exams
Eligible with a detailed receipt		Physical therapy
Not eligible		Physician retainer fee (for on-call or concierge services)
Eligible with a detailed receipt		Pregnancy tests (over-the-counter)
Eligible with a detailed receipt		Prescription Eyeglasses/ contact lenses
Eligible with a detailed receipt		Prescription(Co-insurance, Co-Payment, Deductible)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Propecia (for treatment of a medical condition)
Eligible with a detailed receipt		Prosthesis
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Protein Bars/shakes/powder (not as meal replacement)
Not eligible		Provider discount/coupon
Eligible with a detailed receipt		Psych / therapy
Eligible with a detailed receipt		Psychiatric care/therapy
Eligible with a detailed receipt		Radial keratotomy (RK)
Eligible with a detailed receipt		Radon Test Kit
Eligible with a detailed receipt		Reading glasses (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Recliner ($1000 max)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Reconstructive surgery (following accident or medical procedure or condition)
Eligible with a detailed receipt		Rehydration Liquids - Pedialyte - Eligible
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Rehydration Liquids - Sports drinks - LMN Required
Eligible with a detailed receipt		Removal of benign mole, cyst or tumor
Eligible with appropriate documentation	Requires Prescription from your doctor, plus detailed receipt	Retin-A (for non-cosmetic purposes)
Eligible with a detailed receipt		Rx (prescription)
Eligible with a detailed receipt		Sales tax, shipping and handling fees (for any eligible expense)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Service Animals (for blindness or vision impairment) (with Certificate of Registration)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Service Animals (services not related to blindness or vision impairment) (with Certificate of Registration)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Service Animals (with Certificate of Registration)
Not eligible		Service Animals (without Certificate of Registration)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Smart Watch (Max 125.00)
Eligible with a detailed receipt		Smoking cessation (programs / counseling)
Eligible with a detailed receipt		Smoking cessation drugs (prescription)
Eligible with a detailed receipt		Smoking cessation gum or patches (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Special school (for mental and physical disabilities)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Special/Durable Medical Equipment(rental or purchase)
Eligible with a detailed receipt		Speech therapy
Eligible with a detailed receipt		Spermicidals (over-the-counter)
Eligible with a detailed receipt		Stethoscope
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Storage Fees: (Embryo, Egg, Sperm)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Sun Protective Clothing (Only cost difference between special and regular clothing, plus documentation of cost difference required)
Not eligible		Sunglasses (over-the-counter)
Eligible with a detailed receipt		Sunglasses (prescription)
Not eligible		Sunscreen with SPF <15 or suntan lotion (over-the-counter)
Eligible with a detailed receipt		Sunscreen with SPF 15+ and "broad spectrum", sunburn creams and ointments (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Supplements (for treatment of medical condition)
Eligible with a detailed receipt		Supplies (for treatment of a medical condition)
Eligible with a detailed receipt		Surgery (for non-cosmetic purposes)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Swimming lessons (for treatment of a medical condition)
Not eligible		Teeth bleaching or whitening
Eligible with a detailed receipt		Teeth grinding prevention devices
Eligible with a detailed receipt		Telehealth / Remote Care
Eligible with a detailed receipt		TENS Unit
Eligible with a detailed receipt		Therapy (for treatment of a medical condition)
Not eligible		Tips/Gratuities
Eligible with a detailed receipt		Toothache and teething pain reliever (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Toothpaste, medicated (Only cost difference between medicated and regular toothpaste, plus documentation of cost difference required)
Not eligible		Toothpaste, toothbrush, floss, etc.
Eligible with a detailed receipt		Transgender treatments/surgery
Eligible with a detailed receipt		Transportation: Airfare (for treatment of a medical condition)
Eligible with a detailed receipt		Transportation: Bus, Train, Taxi, Parking expenses (for eligible care/expenses)
Not eligible		Transportation: Bus, Train, Taxi, Parking expenses (for non-eligible care/expenses)
Eligible with a detailed receipt		Tubal ligation
Not eligible		Tuition or educational classes
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Tuition or educational classes (for a specific medical condition)
Eligible with a detailed receipt		Urological products
Eligible with a detailed receipt		Vaccinations
Eligible with a detailed receipt		Varicose vein removal surgery (for medical care)
Eligible with a detailed receipt		Vasectomy
Eligible with a detailed receipt		Viagra and similar prescription medications
Eligible with a detailed receipt		Vision
Eligible with a detailed receipt		Vision - contact lenses solutions
Eligible with a detailed receipt		Vision - Prescription Goggles and Masks
Eligible with a detailed receipt		Vision (Co-insurance, Co-Payment, Deductible) - Eligible
Eligible with a detailed receipt		Vision Contact lenses case
Eligible with a detailed receipt		Vision correction treatment/surgery
Eligible with a detailed receipt		Vision Eye Patch
Eligible with a detailed receipt		Vision: Ortho keratotomy/Orthokeratology
Eligible with a detailed receipt		Vision: Eye Glass Repair Kit
Eligible with a detailed receipt		Vision: Lens Wipes
Eligible with a detailed receipt		Vision: Prescription Eyeglasses/ contact lenses
Not eligible		Vitamins - General Health
Eligible with a detailed receipt		Vitamins - Prenatal
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Vitamins - Treatment of Medical Condition
Eligible with a detailed receipt		Walking aids (canes, walkers, crutches, walking poles with rubber tips, and related supplies)
Not eligible		Walking aids (hiking or trekking poles with carbide tips)
Not eligible		Warranties or other charges for future anticipated services (with none actually received)
Eligible with a detailed receipt		Wart removal treatments (over-the-counter)
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Waterpik flosser
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Weight loss counseling
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Weight loss drugs (over-the-counter)
Not eligible		Weight loss foods
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Weight loss program (for treatment of a medical condition)
Not eligible		Weight loss program (to improve or maintain general health)
Eligible with a detailed receipt		Weight loss Surgery (lap band, Bariatric, etc.)
Eligible with a detailed receipt		Wheelchair and repairs
Eligible with appropriate documentation	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt	Wigs
Eligible with a detailed receipt		Wipes - Hand Sanitizing for the prevention of COVID-19 with 60% + alcohol base
Not eligible		Wipes - Hand Sanitizing with less than 60% alcohol base
Not eligible		Wipes - Surface Wipes
Eligible with a detailed receipt		X-ray
Eligible with a detailed receipt		X-ray (medical)

Eligibility Legend
Symbol		Description
	=	Eligible with a detailed receipt
	=	Not eligible
	=	Eligible with appropriate documentation:

Conditional Requirements Legend
Symbol		Description
	=	Requires Prescription from your doctor, plus detailed receipt
	=	Requires letter of Medical Necessity signed by your doctor, plus detailed receipt