Medical Reimbursement Guide

The following is only a brief list of some of the items that may and may not be eligible for reimbursement. The IRS Regulations and Rulings establish general rules as to the items that are eligible for reimbursement and those which are not.

Eligible medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes.

Medical expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are for cosmetic purposes or are merely beneficial to general health.

The IRS also provides specific examples of items that are, and are not, eligible for reimbursement. Those specific examples change from time to time as technology and medicine evolve. As the Flex Plan becomes aware of changes to the IRS eligible items list, the following list will be updated. New or updated items will be displayed in bold. Therefore, this list is made available without warranty of any kind. The Flex Plan is not engaged in providing legal, accounting or tax advice. The reimbursement list below is subject to change without notice.

If you are unsure or have any doubt if a specific expense will qualify, please contact the Member Services Department prior to purchasing the item or incurring the service. Please note that in order to receive a reimbursement from the Flex Plan, you must submit a properly completed claim form and supporting documentation as well as have the funds available in your Flex Plan Account (subject to two month premium reserve, if applicable). In addition, to be eligible for reimbursement, claims incurred in a calendar year must be received by the Flex Plan by March 31 of the following year.

Please review all of the Claims Reimbursement Instructions on the Medical Expense Reimbursement Claim Form PRIOR to submitting your claim.

You may check your eligibility and the amount available for reimbursement in the Claims Reimbursement Section of the "On-line Account Access" page.

IMPORTANT: Over-the-Counter Medicines or Drugs are only eligible for reimbursement if accompanied by a Prescription issued by a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO) licensed in the state they are practicing.

What over-the-counter items require a prescription?
To be eligible for reimbursement, prescriptions are required for all over-the-counter (OTC) medicines or drugs other than insulin. OTC items that are not medicines or drugs (equipment, medical devices and supplies) are reimbursable without a prescription. Examples of items that do not require a prescription include crutches, bandages, eye glasses, contact lenses, contact lens solution, blood sugar test kits, diabetic supplies and oxygen.

What must a Letter of Medical Necessity contain?
A Letter of Medical Necessity must be issued by a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO) licensed in the state they are practicing, and must be a written order for a drug, over-the-counter medicine, device or treatment that is required for medical treatment or care. The Letter of Medical Necessity must include all required information as defined in the Flex Plan Letter of Medical Necessity Template.

Letter of Medical Necessity Template
We have created a template for your Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) to use to assist them in providing the information necessary in a Letter of Medical Necessity. Click here to view or print the template.

The Letter of Medical Necessity must be issued before the expense is incurred and include the following:


Please click here for a printer friendly version

Expense DescriptionEligibleLetter of Medical Necessity or Prescription NeededDetails
AbortionYesNoLegal abortion only.
Acetaminophen (eg: Tylenol)YesPrescription
AcupunctureYesNo
Acne Treatments (eg: Clearasil, Proactiv)YesPrescription
Air Duct Cleaning/SanitizingNoNo
Air Filter/SuppliesYesLetter
Air PurifierYesLetter
Alcohol & Drug RehabYesNo
Allergy Medicine (eg: Benadryl, Allegra, Claritin, Alavert, Chlor-Trimeton, Dimetane, Zyrtec, Tavist)YesPrescription
Alternative Healers, Dietary Substitutes, Drugs and MedicinesYesLetter
AnesthesiaYesNoOnly for non-cosmetic procedures
Antacids and Acid Relievers (eg: Mylanta, Pepcid, Prilosec, Tums)YesPrescription
Antidiarrheal and Laxatives (eg: Ex-lax, Pepto-Bismol)YesPrescription
Antifungal Cream (eg: Femstat, Monistat, Lamasil, Lotrimin)YesPrescription
Antihistamines (eg: Benadryl, Allegra, Claritin, Alavert, Chlor-Trimeton, Dimetane, Zyrtec, Tavist)YesPrescription
Anti-itch Lotions and Creams (eg: calamine)YesPrescription
Ambulance TransportYesNo
Arm SlingsYesNo
Artifical Limbs and TeethYesNo
Batteries for Durable Medical EquipmentYesNoMust note usage of batteries on receipt.
BandagesYesNo
Bariatric Surgery (Gastric Bypass, Lap-band)YesNo
Bed Wetting AlarmsYesLetterFor children/adults 5 years and older
Birth Control PillsYesNo
Body ScanYesNoThe cost of an electronic body scan.
Blood Pressure Monitoring DeviceYesNo
Blood Sugar Test Kit and Test StripsYesNo
Body Scan/Diagnostic TestingYesNo
BPAP Device(s)YesNoThis includes replacement parts, repair and maintenance.
Breathe Right StripsYesNo
Braille Books and MagazinesYesNo
BracesYesNoSee Orthodontia
Breast Feeding SuppliesYesNoBreast Pumps and supplies (eg: micro steam bags, storage bags, nipple cream) that assist lactation may be reimbursed. Bottles are only reimbursable if the Breast Pump must only use a specific type of bottle.
Breast Reconstructive SurgeryYesNoFollowing a mastectomy for cancer.
Cancer ScreeningsYesNo
Cane/Walking CaneYesNo
Childbirth ClassesYesNoOnly the portion of the class covering the birthing process.
Childbirth HypnosisYesLetter
ChiropractorsYesNo
Christian Science PractitionersYesNo
Cholesterol Test KitsYesNo
Coinsurance and DeductiblesYesNo
Compression Hosiery/SocksYesNoMay include diabetic socks
Concierge Medical CarePotentiallyNoThe cost of joining a Concierge program is not reimbursable nor are monthly or annual fees. However, actual care (eg: physical exam, office visit, etc) by physicians in these programs would be covered after the care is actually provided. Note: Documentation from the provider must clearly itemize the portion that pertains to medical care.
Cold Medicines and Decongestants (eg: Sudafed, Theraflu)YesPrescription
Contact Lenses, Materials and SuppliesYesNo
ContraceptivesYesNo
Costmetic Procedures/SurgeryNoNo
CPAP Device(s)YesNoThis includes replacement parts, repair and maintenance.
CPR ClassesSee DetailsYesCPR classes as part of birthing classes are reimbursable otherwise a letter of medical necessity is required
CrutchesYesNoThe amount you pay to buy or rent crutches is eligible.
DefibrillatorYesNo
Diabetic SocksYesNo
Diabetic SuppliesYesNo
DeductiblesYesNo
Dental CareYesNoFor the prevention and alleviation of dental disease. Preventive treatment includes services of a dental hygienist or dentist for such procedures as teeth cleaning, application of sealants and flouride treatments. X-rays, fillings, braces, extractions, dentures and other dental ailments are also reimbursable. Cosmetic procedures are not eligible.
Dental Implants/ReconstructionYesNo
Dental VeneersNoNo
Doctor VisitsYesNoProvided they are not for unnecessary cosmetic surgery.
Doula (Birthing Coach)YesLetter
Drug AddictionYesNoInpatient treatment at a therapeutic center for drug addiction may be reimbursed. This includes meals and lodging at the center during treatment
DrugsYesPrescriptionPrescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
Drug TestingYesNo
Durable Medical EquipmentYesLetter
Ear PlugsYesLetter
ElectrolysisYesLetterOnly if directly related to treatment of an illness (mental or physical). Cosmetic procedures are not reimbursable.
Exercise Equipment or ProgramsYesLetterRecommended by physician to treat a specific medical condition.
Eyeglasses, Equipment and Materials including over-the-counter Reading GlassesYesNoFor medical reasons.
Eye ExaminationsYesNo
Eye Protection PlanNoNo
Eye SurgeryYesNoFor eye surgery to treat defective vision, such as laser eye surgery or radial keratonomy.
Family CounselingSee DetailsYesFamily therapy/counseling is not reimbursable unless its primary purpose is alleviating a specified individual's mental illness or defect. To be eligible for reimbursement, your doctor must write a "Letter of Medical Necessity" (see above) and state that the primary purpose of the counseling is for the treatment of a mental illness or defect and not to improve family life.
Finance ChargesNoNo
First Aid Creams (eg: Bactine, Neosporin)YesPrescription
First Aid KitYesNo
Fertility Enhancement including ovulation and pregnancy testsYesNo
Fertility TreatmentsYesNoSpouse only, not surrogate
Fiber Supplements (eg: Benefiber, Citrucel, Metamucil)YesPrescription
Flex Plan Admin FeesYesNoAdmin Fees may only be claimed January-March for the prior calendar year. Your total Admin Fees will be displayed on the Claims Reimbursement Status page in January-March of each year.
Flu ShotsYesNo
FoodYesNoThe cost of meals at a hospital or similar institution if a principal reason for being there is to get medical care. You cannot be reimbursed for the cost of meals that are not part of inpatient care.
Gauze PadsYesNo
Genetic TestingSee DetailsYesIf ordered for medical care. Not for paternity testing or to determine the sex of a child.
GlucosamineYesPrescription
Glucose Monitoring EquipmentYesNo
Group TherapySee DetailsLetterSee Family Counseling.
Guidedog;Other Animal AidYesLetterThe costs of buying, training and maintaining a guide dog or other service animal to assist a visually-impared or hearing-impared person, or a person with other physical disabilities.
Hair Loss (eg: Rogaine, Propecia)YesLetterOnly if hair loss is due to a medical condition other than Alopecia. However, not for cosmetic purposes such as stimulation of hair growth for someone who has thinning hair.
Hand Sanitizers,YesNo
HCG (Human chorionic gonadotropin injections)YesLetter
Health Club DuesYesLetterIf recommended by physician to treat a specific medical condition.
Hearing Aids, Devices and BatteriesYesNo
Heart Monitor,YesNo
Health Savings Accounts (HSA)NoNo
Hemmorrhoid Treatments (eg: Preparation H)YesPrescription
Herbs and Herbal Supplements (eg: Echinacea, Ginkgo, St John's Wort)YesPrescription
Hippotherapy (therapeutic horseback riding)PotentiallyLetterRecreational horseback riding is not an eligible expense.
Hormone Replacement Therapy (HRT)See DetailsLetterOnly if used to treat a medical condition.
Hospital ServicesYesNoFor legal operations that are not for unnecessary cosmetic surgery.
HumidifierYesLetter
HypnosisYesLetterWhen recommended by a health care professional for smoking cessation or weight loss, the cost of hypnosis is a qualified limited-purpose expense. Expenses for all other medical care are not reimbursable.
HypnobabiesYesLetter
Ibuprofen (eg: Advil, Motrin, Nuprin)YesPrescription
ImmunizationsYesNo
Incontinence SuppliesYesNo
In-ear MonitorYesLetterAuditory devices used to allow and protect the ability to hear in dangerously loud environments. Must be prescribed solely for the prevention/mitigation of hearing loss.
Insole InsertYesNo
InsulinYesNo
Invisalign BracesYesNoEOB from dental provider or statement of no dental insurance must accompany claim.
IPAP Device(s)YesNoThis includes replacement parts, repair and maintenance.
Laboratory FeesYesNo
Lactation ConsultantYesLetter
Lactose Intolerance (eg: Lactaid),YesPrescription
Lap-band SurgeryYesNo
Laser Hair RemovalNoLetterUnless directly related to treatment of an illness (mental or physical). This item is under review in IRS Tax Court.
Lasik Eye SurgeryYesNo
Laxatives (eg: Benefiber, Citrucel, Correctol, Ex-lax, Kaopectate, Metamucil, Milk of MagnesiaYesPrescription
Lifetime CareNoNoFees or advance payment for a retirement home or continuing care facility.
Liniments (eg: Bengay, Tiger Balm)YesPrescription
Long-term CareYesNo"Qualified" Long-term insurance premiums as defined by IRS Publication 502 subject to the limits which adjust anually.
Marriage CounselingNoNo
Maternity ClothesNoNo
Massage TherapyYesLetterMassages prescribed by a doctor for treating a specific injury or trauma are eligible. You are required to submit a doctor's prescription or referral with your claim that states the specific injury or trauma being treated. Massages to relieve stress and for general health are not eligible.
MidwifeYesNoMidwife must be licensed.
MealsYesNoThe cost of meals at a hospital or similar institution if a principal reason for being there is to get medical care. You cannot be reimbursed for the cost of meals that are not part of inpatient care.
Medical Alert Bracelet (Necklace or Device)YesNo
MedicinesYesPrescriptionPrescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
Medical EquipmentYesNo
Medical Record ChargesYesNo
MedicationsYesPrescriptionPrescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
MileageYesOnly if accompanied by receipt for doctor visit or RXWhile seeking medical services or purchasing a RX, 2018 @ 18c/mile, 2017 @17c/mile
Missed Appointment FeesNoNo
Mold Removal (Household)NoNo
Mona Lisa Touch Laser TherapyYesLetter
Motion Sickness PillsYesPrescription
Nasal Sprays (eg: Afrin, Vicks, Neo-Synephrine)YesPrescription
Nasal Strips (eg: Breathe Clear, Breathe Right)YesNo
Naturopathic HealersSee DetailsLetterExpenses paid to alternative providers for naturopathic or holistic treatments or procedures are not covered unless to treat a specific medical condition.
Nebulizers, CPAP, BIPAPYesNo
Nursing ServicesYesNoServices may be provided in-home or at a facility. Only services related to the care and monitoring of a specific medical condition are eligible. Household/personal services (ie cooking, cleaning) are not eligible.
NutritionistSee DetailsLetterWhen recommended by a health care professional for treatment of a specific medical condition.
Occlusal Guards (teeth night guards)YesPrescriptionThe over-the-counter guards require a prescription. If the guard is acquired through your provider, a prescription is not required.
Occupational TheraphyYesNo
OperationsYesNoFor legal operations that are not for unnecessary cosmetic surgery.
Optometrist, Eyeglasses, Equipment and MaterialsYesNoFor medical reasons.
OrthodontiaYesNoEOB from dental provider or statement of no dental insurance must accompany claim. Copy of contract required or documentation from provider showing: Provider Name/Address/Phone Number, Patient Name, total case fee, initial and monthly fees, treatment period (start and end dates). Itemized statement from provider.
Orthopedic InsertsYesLetter
Orthopedic ShoesYesLetter
Oral Electrolytes (eg: Pedialyte)YesPrescription
OsteopathYesNoFor medical care.
Ovulation MonitorYesNo
Ovulation Test (over the counter)YesNo
Oxygen and Oxygen EquipmentYesNoTo relieve breathing problems caused by a medical condition.
Pain Relievers (eg: Advil, Aleve, Excedrin, Motrin, Tylenol)YesPrescription
ParkingYesOnly if accompanied by receipt for doctor visit or RXWhile seeking medical services or purchasing prescriptions. Parking fee over $2 must be accompanied by a receipt that matches corresponding date of service.
Pediculicide - Head Lice Treatment (eg: Rid)YesPrescription
Physical Examination and Diagnostic TestsYesNoPerformed by a physician.
Physical TherapyYesNo
Pilot's HeadsetYesLetterHeadset designed and prescribed to prevent hearing loss in individuals working in environments which could cause hearing damage.
Placental EncapsulationYesLetter
Pregnancy Aids (eg: Maternity Support Belts, Maternity Girdles)YesNo
Pregnancy Test (over the counter)YesNo
Pregnancy Test KitYesNo
Prenatal Vitamins & SupplementsYesLetterIf taken during pregnancy.
Prescription Drug Discount ProgramsNoNo
Prescription Drugs (Rx)YesPrescriptionPrescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
ProsthesisYesNo
Psychiatrist and Phychiatric CareYesNo
PsychoanalysisYesNoProvide that it is not part of required training to be a psychoanalyst.
PsychologistYesNoIndividual counseling/therapy is covered.
Radial KeratotomyYesNo
Reversal of Tubal Ligation or VasectomyYesNo
Sales Tax on Qualified Medical ExpensesYesNoSales tax will automatically be reimbursed if receipt is eligible for reimbursement.
Screening TestsYesNo
Shipping and Handling Fees for Eligible ExpensesYesNo
Shoe InsertYesNo
Sleep Aids (Sominex, Tylenol PM, Unisom)YesPrescription
Sleep Deprivation Treatment (eg: Breathe Right, NoDoz, Nytol, Sominex, Unisom)YesPrescription
Speech TherapyYesNo
Stem Cell, Harvesting and/or StorageSee DetailsLetterCollection and storage if needed for treatment of specific medical condition would be eligible. Collection and storage indefinately, just in case it is needed, is not eligible.
SterilizationYesNoA legally performed operation to make a person unable to have children.
Stop Smoking ProgramsYesNoYou may not be reimbursed for drugs that do not require a prescription such as nicotine gum or patches that are designed to help stop smoking, unless they are prescribed as described above.
Stop Smoking DrugsSee DetailsNoPrescribed Drugs are reimbursable. Drugs that do not require a prescription, such as nicotine gum or patches, are not reimbursable.
Sunburn Creams (eg: Solarcaine)YesPrescription
SurgeryYesNoFor legal operations that are not cosmetic.
Teeth WhiteningNoNo
Throat Lozenges or cough drops (eg: Chloraseptic, Cepacol, Halls, Ricola, Sucrets)YesPrescription
TNS UnitYesNo
Toothache or Teething Pain Relievers (eg: Orajel)YesPrescription
Tooth Brush and/or ToothpasteNoNo
TransplantsYesNo
Transcranial Magnetic Stimulation (TMS)YesLetterUnless covered by insurance
Transportation and Travel Expenses for Person Receiving Medical CareYesNoTransportation expenses may be reimbursed when the transportation is primarily for, and essential to, medical care. Transportation expenses for a personal vehicle can be reimbursed based on a mileage rate determined by the IRS, which is subject to change.
Tubal LigationYesNo
Umbilical Cord, Freezing and Storing ofSee DetailsYesCollection and storage if needed for treatment of specific medical condition would be eligible. Collection and storage indefinately, just in case it is needed, is not eligible.
VaccinesYesNo
Varicose Veins, treatment ofYesNo
VasectomyYesNo
VeneersNoNo
Virtual Physical Body ScanYesNo
Vision Correction SurgeryYesNoFor eye surgery to treat defective vision, such as laser eye surgery or radial keratonomy.
Vitamins & SupplementsYesLetterNot reimburable for general well being. Must be for the treatment of a specific medical condition.
WalkerYesNo
Wart Removal Treatment (eg: Compound W, Dr. Sholl's, Tinamed)YesPrescription
Weight-loss Programs and/or Drugs Prescribed to Induce Weight LossYesLetterIf the treatment is for specific disease diagnosed by physician (such as obesity, hypertention or heart disease). This includes fees you pay for membership in a weight reduction group as well as fees for attendance at periodic meetings.
Wheelchair/AutoetteYesNo
WigYesLetterIf purchased upon advice of a physician for the mental health of a patient who has lost all of his or her hair from disease.
X-Ray FeesYesNo
Yoga ClassesYesLetter