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.

Eligible expenses search and results

Displaying expenses 46–60 of 107
Eligible expenses. Each row shows whether the expense is eligible and any documentation needed.
Expense Eligible? Documentation Needed
Invisalign and other clear dental aligners (including self-service mail order) Eligible with detailed receipt
Lasik Eligible with detailed receipt
Late payment fees charged by health care provider Not eligible
Lodging (limited to $50 per night for patient to receive dental or vision care and $50 per night for one caregiver) Eligible with detailed receipt Requires prescription from 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
Massage Memberships Dues Not eligible
Maternity clothes Not eligible
Medical literature, books, pamphlets or audio Not eligible
Mileage (for travel to / from anything other than eligible care) Not eligible
Mileage (for travel to/from eligible dental care) Eligible with detailed receipt
Mileage (for travel to/from eligible vision care) Eligible with detailed receipt
Misc. Personal Use Items Not eligible
Missed Appointment Fee Not eligible
Nursing Home Care Not eligible
Occlusal guards to prevent teeth grinding Eligible with detailed receipt
  • Eligible with detailed receipt
  • Not eligible
  • Requires prescription from your doctor, plus detailed receipt
  • Requires Letter of Medical Necessity signed by your doctor, plus detailed receipt