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Fsa eligible - extensive list.xls

FSA Eligible ExpensesCrosby Benefit Systems, Inc.
www.crosbybenefits.comVersion: 3/10/2009 IMPORTANT: The following is a list of common medical, dental and vision related items and services. Crosby determines "Eligible" based on IRS guidance. Crosby's interpretation is subject to change without notice. This list is intended only as a general guideline because all submitted expenses will be reviewed on a case-by-case basis based on the documentation provided.
*In most cases, a Dual Purpose item will require a medical practitioner note to verify medical necessity. A medical practitioner note may be written by a doctor of medicine, dentistry, podiatry, optometry, an authorized chiropractor, an alternative healer or other qualified medical practitioner and must contain the following: 1. date; 2. patient’s name; 3. medical practitioner’s name; 4. statement of medical necessity; 5. the prescribed treatment; and 6. the duration of treatment required.
Oral Medications, Nasal Sprays & Patches Anti-Itch & Hydrocortisone Creams Benadryl, Caladryl, Cortaid Crosby Benefit Systems, Inc.
Makeup, Lipstick, Cotton Swabs, Cotton Balls, Not EligibleBaby Oil Marriage and couples counseling are ineligible Dual purpose* Toothache Relief, Temporary Filling, Denture EligibleAdhesives Crosby Benefit Systems, Inc.
Condoms, Contraceptive Creams, Pregnancy Bandages, Tape, Gauze Dressing, Adhesive Pads, Band-Aids Arch & Insole Supports, Callous Removers, Athlete's Foot Treatment, Nail & Foot Antifungal creams Color, Shampoo, Conditioner, Brushes, Hair- colorectal, HIV, urine test, thermometers Adult Diapers, i.e. Depends and Serenity Pads Eligible For mother only. Expenses for the coach or For late payment of bills for medical services Crosby Benefit Systems, Inc.
InstitutionLodging Not at a Hospital or Similar Up to $50 per night if used primarily for and essential to medical care provided by a physician in a licensed hospital or medical care facility and there is no element of personal pleasure recreation or vacation in the travel Will qualify if accompanying a patient for medical reason and all of the following conditions apply: up to $50 per night if used primarily for and essential to medical care provided by a physician in a licensed hospital or medical care facility and there is no element of personal pleasure recreation or vacation in the travel Rolfing, Craniosacral Therapy, Myofacial InstitutionMeals Not at a Hospital or Similar ConferenceMedical Alert Bracelet or Necklace Transportation, MealsMedical Information Plan Charges Expenses for Transportation Primarily for & Crosby Benefit Systems, Inc.
Wages, employment taxes and other amounts Dual Purpose* paid for nursing services generally will qualify. If person is providing household and personal services, these do not qualify.
Nutritional & Dietary Supplements Bars, Milkshakes, Power drinks Cream, Razors, Feminine Care, Sanitary Products Toothpaste, Toothbrush, Electric Toothbrush, Not EligibleFloss, Mouthwash Including Antibacterial Mouthwash & Fluoride Rinse, Breath Strips, Teeth-Whitening Treatment of LiceShipping & Handling Fees Skin & Body Moisturizing Lotion, Lip Balm Crosby Benefit Systems, Inc.
Antiperspirant, Lip Balm, Perfume, Cologne Drugs Prescribed to Induce Weight LossWheelchair Crosby Benefit Systems, Inc.

Source: http://www.crosbybenefits.com/_Documents/Form/19/FSAEligibleItems-ExtensiveList.pdf

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