Your Flexible Spending Accounts
What’s Covered
Brought to you by
FSA Eligible Health Care Expenses
(Below is the list of items typically covered by a standard FSA. For a complete list visit www.wageworks.com)
Rx (prescription)
Co-payment (dental)
Lamaze classes
Co-payment (medical)
Co-payment (medical)
Laser eye surgery
Office visit (medical)
Co-payment (other)
Lasik
Dental
Co-payment (vision)
Laxatives (over-the-counter)
Over-the-counter (eligible)
Corn and callus remover (over-the-counter)
Learning disability treatments
Vision
Corneal keratotomy
Lice treatment (over-the-counter)
Psychotherapy
Listening therapy
Chiropractic care
Cough drops & sore throat lozenges
(over-the-counter)
Lab (medical)
Cough syrup (over-the-counter)
Medical abortion
Orthodontia
Counseling (for treatment of a medical condition)
Medical co-insurance
Hospital fees
Medical co-payment
X-ray (medical)
Crutches, canes or like equipment
(purchase or rental)
Acne treatments (over-the-counter)
Deductible for dental plan
Medical equipment (for treatment of medical
condition) and repairs
Acupuncture
Deductible for medical plan
Deductible for prescription plan
Medical monitoring and testing devices
Adoption (medical expenses related to)
Alcoholism treatment
Deductible for vision plan
Allergy & sinus medicine and products
(over-the-counter)
Dental care (for non-cosmetic purposes)
Allergy medication (prescription)
Dental co-payment
Ambulance and emergency health services
Dental reconstruction
Anesthesia (for non-cosmetic purposes)
Dentures, bridges, etc.
Antacid (over-the-counter)
Diabetic monitor, test kits, strips and supplies
Antibiotic ointment (over-the-counter)
Diagnostic services
Aspirin or other pain reliever (over-the-counter)
Diaper rash ointments and creams
Asthma medicines or treatments
(over-the-counter)
Drug addiction treatment
Athletic treatments / braces
Dyslexia treatment
Bandages and related items (over-the-counter)
Birth control (over-the-counter)
Birth control (prescription or other)
Blood pressure monitor
Blood suger test kits and test strips
Body scans
Canker & cold sore treatments (over-the-counter)
Dental co-insurance
Drugs (prescription)
Eye examinations
Eye related equipment/materials
Eye surgery or treatment to correct vision
Eyeglasses (over-the-counter)
Eyeglasses (prescription)
Fertility monitor (over-the-counter)
Chest rubs (over-the-counter)
Fertility treatment
(for employee, spouse or dependent)
Childbirth classes
First aid kit (over-the-counter)
Chiropractic office visit or treatment
Cholesterol test kits and supplies
Christian Science practitioners
Co-insurance (dental)
Co-insurance (medical)
Co-insurance (prescription)
Co-insurance (vision)
Flu shots
Gastrointestinal medication (over-the-counter)
Guide dog (dog, training, care)
Hearing aids and batteries
Hospital services and fees
Immunizations
Mastectomy-related special bras
Medical records charges
Medicines (over-the-counter)
Medicines (prescription)
Midwife
Mileage
Monitors & test kits (over-the-counter)
Motion & nausea
Nasal sprays & strips (over-the-counter)
Non-prescription drugs and medicines
(for non-cosmetic purposes)
Norplant insertion or removal
Nursing services (wages and taxes)
OB/GYN fees
Occlusal guards to prevent teeth grinding
Occupational therapy
(related to a medical condition or disability)
Office visits (chiro)
Office visits (dental)
Office visits (medical)
Office visits (psych / therapy)
Office visits (vision)
Operations (for non-cosmetic purposes)
Optometrist / ophthalmologist fees
Organ transplants (recipient and donor)
Ortho keratotomy
Orthodontia (braces and retainers)
Orthopedic & surgical supports
Over-the-counter acne treatments
Cold & flu medicine (over-the-counter)
Incontinence products
(excludes diapers and diaper services)
Compression or anti-embolism socks,
stockings or hose
Infertility treatment
(for employee, spouse or dependent)
Over-the-counter antacid
Condoms and spermicides
Insulin, testing materials and supplies
Over-the-counter aspirin or other pain reliever
Contact lenses, cleaning solutions, etc.
Laboratory fees
Contraceptives (prescription or over-the-counter)
Lactose intolerance (over-the-counter)
Over-the-counter asthma medicines or
treatments
Over-the-counter allergy & sinus medicine
Over-the-counter antibiotic ointment
Turn over for more E
Over-the-counter bandages and related items
Prescription co-payment
Surgery (for non-cosmetic purposes)
Over-the-counter canker & cold sore treatments
Prescription drugs (for non-cosmetic purposes)
Teeth grinding prevention devices
Over-the-counter chest rubs
Prosthesis
Over-the-counter cold & flu medicine
Psychiatric care
Toothache and teething pain reliever
(over-the-counter)
Over-the-counter cold & flu prevention
Psychoanalysis
Therapy (for treatment of a medical condition)
Over-the-counter cough drops &
sore throat lozenges
Psychologist fees
Toothache and teething pain relievers
Radial keratotomy (RK)
Tubal ligation
Over-the-counter cough syrup
Reading glasses (over the counter)
Urological products
Over-the-counter health care products (eligible)
Removal of benign mole, cyst or tumor
Vaccinations
Over-the-counter medication (including for
motion sickness, sleep aids and sedatives)
Sales tax, shipping and handling fees
(for any eligible expenses on this list)
Varicose vein removal surgery
Over-the-counter products for dental ailments
(including oral and teething pain)
Smoking cessation (programs / counseling)
Over-the-counter vision products
Smoking cessation gum or patches
(over-the-counter)
Ovulation monitor (over-the-counter)
Oxygen
Pain reliever (over-the-counter)
Physical exams
Physical therapy
Pregnancy tests (over-the-counter)
Prescription co-insurance
Smoking cessation drugs (prescription)
Speech therapy
Sterilization
Student health fees billed for services actually
received (dental / medical / vision / prescription)
Vasectomy
Viagra and similar prescription medications
Vision co-insurance
Vision co-payment
Vitamins (prescription)
Walking aids
(canes, walkers, crutches and related supplies)
Wart removal treatments (over-the-counter)
Sunglasses (prescription)
Wheelchair and repairs
Sunscreen with SPF 30+, sunburn creams and
ointments (over-the-counter)
X-ray fees (dental / medical)
Wound care (over-the-counter)
FSA “Maybe” Eligible Health Care Expenses
Certain expenses require additional information in order to determine if they qualify. Products and services classified as “Maybe” require a written
statement from your health care provider indicating (1) the diagnosis and (2) the medical necessity of the expense. Specialized items also require proof
of the difference in cost: (1) the cost of standard, unmodified item, and (2) the cost of special or modified item. If you incur an expense that is classified as
“Maybe,” you will need to submit the above documentation with your claim.
Allergy treatments
Dietary supplements*
Alternative dietary supplements*
Exercise equipment*
Reconstructive surgery (following accident or
medical procedure or condition)
Alternative drugs and medicines*
Fitness programs*
Retin-A (for non-cosmetic purposes)
Health club dues*
Rogaine or other hair regrowth medications*
Home improvements*
Special equipment
Breast pump
(to compensate for a medical condition)
Humidifier, air filter and supplies
Special foods (gluten-free, salt-free or other for
treatment of a medical condition)
Breast reconstruction surgery
(following mastectomy)
Massage therapy*
Alternative healers*
Braille books and magazines
(difference in cost only)
Car modifications*
Cord blood storage (for future treatment of a birth
defect or known medical condition)
Dancing lessons*
Lodging (essential to receive medical care)
Medical supplies*
Modified equipment (difference in cost only)
Nutritional supplements*
Dental products (for treatment of a dental
condition, not general health)
Orthopedic shoes and inserts
(difference in cost only of specialized orthopedic
shoe over like non-specialized shoe)
Dental veneers
Propecia*
Special school (for mental and physical disabilities)
Supplies*
Swimming lessons*
Transgender treatments / surgery
Transportation, parking and related travel
expenses (essential to receive medical care)
Weight loss counseling
Weight loss program or drugs*
* As required or treatment for a medical condition diagnosed by a licensed health care professional.
Brought to you by
WW-FSA-EXPENSE-HC (Aug 2008)
www.wageworks.com