Encircled icon of a desktop computer monitorEncircled hand hold a mobile device on which the screen shows a check markArrow pointing leftArrow pointing rightAt symbol indicating an email addressInstitution IconMenu IconGo to first page symbolClosed book iconBookmark with tabsEncircled image of a handheld calculatorCalculator IconEncircled monthly calendarCalendar shaped box with checkmarkMonth view of a CalendarCaret DownCaret LeftCaret RightCheckmark on a circlular backgroundCheck mark in a square boxChild IconCircleClock faceClose or Cancel symbolThree cogs enmeshedComment bubbleComment bubbleTwo comment bubbles addressing each other in conversationIcon indicating a database as a stack of circlesEncircled image of a small hand laid atop a larger handDependent Care FSA IconDesktop computer monitor over a circle with a shadowDesktop computer iconEncicled open document folderMoney IconEncircled dollar signUS Dollar symbolDotted Arrow IconEdit IconGo to last page symbolPen with checked checkbox within a circleEnvelope IconExclamation Mark within a Triangular SignEncircled hand holding dollar billsAmerican FlagEncircled compassEye IconFacebook LogoEdit IconStar IconFax IconEncircled hand holding a dollar signAdobe Acrobat PDF iconSingle, blank file iconTwo files in a stackLightning bolt symbolEncircled file iconA group of peopleEncircled white crossHealth Care Flexible Spending Account IconHeartbeat IconEncircled "i" characterText file icon symbolizing a paper letterEncircled image of two files, one laid above the otherEncircled icons of a tooth and an eyeLimited Expense Healthcase FSA IconEncircled lightbulbList IconLock IconEncircled megaphoneMedkit IconEncircled chat bubbleMobile phone over a circle with a shadowPause IconEncircled stack of coinsPhone IconPlay IconMouse Pointer IconPrescription SymbolPrinter IconQuestion Mark IconEncircled question markEncircled cloud with download symbolSearch IconSecure EmailSign In IconSign out of this siteSpinning circle indicating a process is activeEncircled starStar IconWrench within a circleTwitter LogoUser Icon with Plus SymbolDownload on the App StoreFSAFEDS LogoGet it on Google PlayUnited States Office of Personnel ManagementAmerican FlagVideo IconDownload Icon

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

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.

Currently showing 15 items per page. Activate to choose another option.
15 50 100
106 results found, Showing page 7 of 8
Displaying expenses 91-105 of 106
Eligible? Additional Document Expense
Not eligible 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 Warranties or other charges for future anticipated services (with none actually received)
Eligible with appropriate documentation Requires letter of Medical Necessity signed by your doctor, plus detailed receipt Waterpik flosser
Not eligible Weight loss foods
Currently showing 15 items per page. Activate to choose another option.
15 50 100
106 results found, Showing page 7 of 8
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