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F8276r08.qxd

Which medical expenses can be paid for with tax-deductible FSA funds?
The following is a partial list of eligible/potentially eligible/ineligible medical expenses. If you have any questions about anitem’s eligibility, please contact SelectAccount® customer service at (651) 662-5065 or toll free at 1-800-859-2144.
Eligible medical expenses
Patient responsibilities under the medical, dental or vision plan solely because of the plan’s deductible, copay (coinsurance), reasonable and customary Eyeglasses – prescription sunglasses/safety glasses Physical exams (routine, medical, well-child) Fertility treatments (e.g., artificial insemination, Prescription drugs (prescription drugs imported from Fluoridation treatment at a dental office Preventive care screenings (e.g., mammogram, Childbirth/lamaze classes (related to birth) Chiropractic treatments (e.g., adjustments) Shipping and handling fees for eligible expenses Coinsurance amounts (health, dental or vision) Individual counseling (counseling must be performed to alleviate or prevent a physical or mental defect or Convalescent home (for medical treatment only) Transportation expenses relative to health care (corresponding medical documentation requested) Dental procedures, non-cosmetic (e.g., X-rays, Occlusal guards to prevent teeth grinding Organ transplant (including donor’s expenses) Diabetic supplies (e.g., insulin, syringe, monitor, Potentially eligible medical expenses (requires Letter of Medical Necessity from health care provider)
Air conditioner (capital expense)
Medical conference admission and transportation Guide dog/service animal (purchase, care for, Mentally handicapped residential or group home Automobile modifications (capital expense) Prescription drugs that also have a cosmetic purpose(e.g., Retin-A, Rogaine, Botox, Propecia) Breast reduction surgery that is medically necessary Home improvements (e.g., exit ramps, widening doorways) (capital expense) Special education costs for dependents with disabilities Cosmetic surgery (for repair or reconstruction afteraccident or surgery or for correction of birth defect) Household products/improvements to treat allergies Telephone/television equipment for hearing-impairedpersons Weight loss program and medications (if prescribed Lodging (away from home for outpatient care – special rules may apply) by a physician for a specific medical condition – Ineligible medical expenses
Birthing tubs
Prescription drugs and medicines imported from Late fees (e.g., for late payment of bills for Lodging while attending a medical conference Cosmetics, hygiene products and similar items Marijuana or other controlled substances in Transportation costs of disabled individual Feminine hygiene products (e.g., tampons) Non-prescription eyeglasses, sunglasses, safety Eligible medical expense
Capital expense
Medical expenses that can be reimbursed through your FSA A capital expense is an improvement and/or special equipment added include services and supplies incurred by you or your eligible to a home or other capital expenditure that may be eligible if the dependents for the diagnosis, treatment or prevention of primary purpose is medical care. A Letter of Medical Necessity is disease or for the amounts you pay for transportation to get required from your health care provider. To submit your capital expense, you must have an appraisal of your home within one year prior to the installation and an appraisal after the installation to In general, deductions allowed for medical expenses on determine the value added to the home. The amount eligible is the your federal income tax according to Internal Revenue Code difference between the cost of the expense and the increase in the Section 213 (d) may be reimbursed through your FSA. You additional value of your home. If the improvement/special cannot deduct medical expenses on your federal income tax equipment is used by individuals other than the person needing it that have been reimbursed through your FSA. It is possible for medical care, the eligible amount should be divided by the that changes in the IRS rules can affect the eligible, potentially number of people using the item. Example: A ramp is purchased for eligible, and/or ineligible expense categories. $3,000 and prior to installation your house is appraised at $100,000.
Potentially eligible medical expenses
After installation of the ramp your house is appraised for $101,000. In order to determine eligibility for potentially eligible items, The amount that is eligible under your FSA is $2,000. SelectAccount requires a Letter of Medical Necessity from For assistance in calculating capital expense, the Capital Expense your health care provider. You can obtain a Letter of Medical Worksheet is available at www.selectaccount.com. If you have
Necessity to have your health care provider complete at questions about a capital expense, please contact customer service www.selectaccount.com.
These lists are intended to serve as a quick reference and are provided with the understanding that SelectAccount is not engaged in rendering tax advice. For more detailed information, please refer to IRS Publication 502, “Medical and DentalExpenses,” Catalog Number 15002Q. Publications can be ordered from the IRS by calling 1-800-TAX-FORM (1-800-829-3676). If tax advice is required, seek the services of a competent professional.

Source: http://mnscsc.org/South_Central_Service_Cooperative/media/Insurance/F8276FSAEligibleExpenseListing.pdf

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