Eligible Limited Expense Health Care FSA Expenses - FSAFEDS

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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.

Displaying expenses 91–105 of 107

Eligible expenses. Each row shows whether the expense is eligible and any documentation needed.
Expense	Eligible?	Documentation Needed
Viagra and similar prescription medications	Not eligible
Vision	Eligible with detailed receipt
Vision - contact lenses solutions	Eligible with detailed receipt
Vision - Prescription Goggles and Masks	Eligible with detailed receipt
Vision (Co-insurance, Co-Payment, Deductible) - Eligible	Eligible with detailed receipt
Vision Contact lenses case	Eligible with detailed receipt
Vision correction treatment/surgery	Eligible with detailed receipt
Vision Eye Patch	Eligible with detailed receipt
Vision: Ortho keratotomy/Orthokeratology	Eligible with detailed receipt
Vision: Eye Glass Repair Kit	Eligible with detailed receipt
Vision: Lens Wipes	Eligible with detailed receipt
Vision: Prescription Eyeglasses/ contact lenses	Eligible with detailed receipt
Walking aids (hiking or trekking poles with carbide tips)	Not eligible
Warranties or other charges for future anticipated services (with none actually received)	Not eligible
Waterpik flosser	Eligible with detailed receipt	Requires prescription from your doctor, plus 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