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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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Displaying expenses 76-90 of 106
Eligible? Additional Document Expense
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)
Not eligible Service Animals (services not related to blindness or vision impairment) (with Certificate of Registration)
Not eligible Smoking cessation drugs (prescription)
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)
Not eligible Teeth bleaching or whitening
Eligible with a detailed receipt Teeth grinding prevention devices
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 Transportation: Bus, Train, Taxi, Parking expenses (for eligible care/expenses)
Not eligible Transportation: Bus, Train, Taxi, Parking expenses (for non-eligible care/expenses)
Not eligible Tuition or educational classes
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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