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
| Expense | Eligible? | Documentation Needed |
|---|---|---|
| Adoption fees | Not eligible | |
| Birth control (prescription) | Not eligible | |
| Child or newborn care instruction | Not eligible | |
| Contact lenses and solutions | Eligible with detailed receipt | |
| Cord blood storage (for unidentified future use) | Not eligible | |
| Corneal keratotomy | Not eligible | |
| Cosmetic procedures or surgery | Not eligible | |
| Counseling (marriage) | Not eligible | |
| CPR classes (adult or child) | Not eligible | |
| Dental | Eligible with detailed receipt | |
| Dental Sealants | Eligible with detailed receipt | |
| Dental (Co-insurance, Co-Payment and Deductible) | Eligible with detailed receipt | |
| Dental (for non-cosmetic purposes) | Eligible with detailed receipt | |
| Dental Bridge | Eligible with detailed receipt | |
| Dental Denture | Eligible with detailed receipt | |
| Dental Implants | Eligible with detailed receipt | |
| Dental products for general health | Not eligible | |
| Dental veneers | Requires Letter of Medical Necessity signed by your doctor, plus detailed receipt | Requires prescription from your doctor, plus detailed receipt |
| Denture Adhesive (Fixodent) | Eligible with detailed receipt | |
| Denture Cleaner (Efferdent) | Eligible with detailed receipt | |
| Diapers and diaper services | Not eligible | |
| Doula (emotional support, parenting information, childcare, and housekeeping) | Not eligible | |
| Drugs (imported) | Not eligible | |
| Educational classes or tuition | Not eligible | |
| Electrolysis | Not eligible | |
| Exceed Plan Maximum | Not eligible | |
| Excessive Mileage | Not eligible | |
| Eye drops and treatments (over-the-counter) | Eligible with detailed receipt | |
| Eye examinations | Eligible with detailed receipt | |
| Eyeglasses (prescription) | Eligible with detailed receipt | |
| Face lifts | Not eligible | |
| Feminine hygiene care (deodorants, general cleansing products, feminine spray) | Not eligible | |
| Fertility treatment (for non-dependent surrogate) | Not eligible | |
| Finance Charges | Not eligible | |
| Funeral expenses | Not eligible | |
| Hair regrowth products | Not eligible | |
| Hair removal | Not eligible | |
| Hair transplant | Not eligible | |
| Hand lotion (over-the-counter) | Not eligible | |
| Household help | Not eligible | |
| Hygiene Products (toothbrush, lotion, soap, etc.) | Not eligible | |
| Illegal operations or substances | Not eligible | |
| Insect Repellant | Not eligible | |
| Insurance Payment/Adjustment | Not eligible | |
| Insurance Premiums | Not eligible | |
| 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) | Requires Letter of Medical Necessity signed by your doctor, plus 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 | |
| Office visits (vision) | Eligible with detailed receipt | |
| Optometrist / ophthalmologist fees | Eligible with detailed receipt | |
| Oral care (over-the-counter) | Not eligible | |
| Ortho keratotomy | Eligible with detailed receipt | |
| Orthodontia | Eligible with detailed receipt | |
| Orthodontia (braces and retainers) | Eligible with detailed receipt | |
| Over-the-Counter medication (2019 Requires Prescription from your doctor) | Not eligible | |
| Payment Processing Fees | Eligible with detailed receipt | |
| Physician retainer fee (for on-call or concierge services) | Not eligible | |
| Prescription Eyeglasses/ contact lenses | Eligible with detailed receipt | |
| Prescription(Co-insurance, Co-Payment, Deductible) | Not eligible | |
| Provider discount/coupon | Not eligible | |
| Radial keratotomy (RK) | Eligible with detailed receipt | |
| Reading glasses (over-the-counter) | Eligible with detailed receipt | |
| Rx (prescription) | Not eligible | |
| Sales tax, shipping and handling fees (for any eligible expense) | Eligible with detailed receipt | |
| Service Animals (for blindness or vision impairment) (with Certificate of Registration) | Requires Letter of Medical Necessity signed by your doctor, plus detailed receipt | Requires prescription from your doctor, plus detailed receipt |
| 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) | Not eligible | |
| Sunglasses (prescription) | Eligible with detailed receipt | |
| Sunscreen with SPF <15 or suntan lotion (over-the-counter) | Not eligible | |
| Teeth bleaching or whitening | Not eligible | |
| Teeth grinding prevention devices | Eligible with detailed receipt | |
| Toothache and teething pain reliever (over-the-counter) | Eligible with detailed receipt | |
| Toothpaste, medicated (Only cost difference between medicated and regular toothpaste, plus documentation of cost difference required) | Requires Letter of Medical Necessity signed by your doctor, plus detailed receipt | Requires prescription from your doctor, plus detailed receipt |
| Toothpaste, toothbrush, floss | Not eligible | |
| Transportation: Bus, Train, Taxi, Parking expenses (for eligible care/expenses) | Eligible with detailed receipt | |
| Transportation: Bus, Train, Taxi, Parking expenses (for non-eligible care/expenses) | Not eligible | |
| Tuition or educational classes | Not eligible | |
| 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 |
- Eligible with detailed receipt
- Eligible with additional documentation and a detailed receipt
- Not eligible
- Requires Letter of Medical Necessity signed by your doctor, plus detailed receipt
- Requires prescription from your doctor, plus detailed receipt