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Eligible Limited Expense Health Care FSA (LEX HCFSA) Expenses

Your Limited Expense Health Care FSA pays for qualifying dental and vision services and certain products.

Various Eligible Expenses

You can use your Limited Expense Health Care FSA (LEX HCFSA) funds to pay for a variety of dental and vision 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 LEX HCFSA 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.

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106 results found, Showing page 2 of 8
Displaying expenses 16-30 of 106
Eligible? Additional Document Expense
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)
Not eligible Diapers and diaper services
Not eligible Doula (emotional support, parenting information, childcare, and housekeeping)
Not eligible Drugs (imported)
Not eligible Educational classes or tuition
Not eligible Electrolysis
Not eligible Exceed Plan Maximum
Not eligible Excessive Mileage
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)
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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