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: Due to the recently passed CARES Act, effective January 1, 2020, Over-the-Counter Medicines and Drugs are now reimbursable.

Who may write a Prescription?
For the purposes of seeking reimbursement from the Flex Plan, a prescription may only be issued by a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO) licensed in the state they practice.

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 practice, 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:

• name of patient,
  
• date of issue,
  
• name and quantity of the drug, medicine, device or treatment prescribed,
  
• prescriber (name, address, telephone, license classification, and federal registry number if applicable),
  
• specific medical condition being treated,
  
• a statement that the treatment is medically necessary and is not for general health or cosmetic in nature,
  
• duration of the treatment (may not exceed one year),
  
• prescriber's signature.
  

Expense Description	Eligible	Letter of Medical Necessity or Prescription Needed	Details
Abortion	Yes	No	Legal abortion only.
ACE Wrap	Yes	No
Acetaminophen (eg: Tylenol)	Yes	No
Acupuncture	Yes	No
Acne Laser Treatment	Yes	Letter
Acne Treatments (eg: Clearasil, Proactiv)	Yes	No
Air Duct Cleaning/Sanitizing	No	No
Air Filter/Supplies	Yes	Letter
Air Purifier	Yes	Letter
Alcohol & Drug Rehab	Yes	No
Allergy Medicine (eg: Benadryl, Allegra, Claritin, Alavert, Chlor-Trimeton, Dimetane, Zyrtec, Tavist)	Yes	No
Alternative Healers, Dietary Substitutes, Drugs and Medicines	Yes	Letter
Anesthesia	Yes	No	Only for non-cosmetic procedures
Antacids and Acid Relievers (eg: Mylanta, Pepcid, Prilosec, Tums)	Yes	No
Antidiarrheal and Laxatives (eg: Ex-lax, Pepto-Bismol)	Yes	No
Antifungal Cream (eg: Femstat, Monistat, Lamasil, Lotrimin)	Yes	No
Antihistamines (eg: Benadryl, Allegra, Claritin, Alavert, Chlor-Trimeton, Dimetane, Zyrtec, Tavist)	Yes	No
Anti-itch Lotions and Creams (eg: calamine)	Yes	No
Ambulance Transport	Yes	No
Arm Slings	Yes	No
Artifical Limbs and Teeth	Yes	No
Back Brace	Yes	Letter
Batteries for Durable Medical Equipment	Yes	No	Must note usage of batteries on receipt.
Bandages	Yes	No
Bariatric Surgery (Gastric Bypass, Lap-band)	Yes	No
Bed Wetting Alarms	Yes	Letter	For children/adults 5 years and older
Bee Sting Kit	Yes	No
Birth Control Pills	Yes	No
Birthing Tub	Yes	No
Body Scan	Yes	No	The cost of an electronic body scan.
Blood Pressure Monitoring Device	Yes	No	For personal use only. Commercial use items are not reimbursable.
Blood Sugar Test Kit and Test Strips	Yes	No
Body Scan/Diagnostic Testing	Yes	No
BPAP Device(s)	Yes	No	This includes replacement parts, repair and maintenance.
Breast Augmentation (implants/injections)	No	Yes	Possibly if there is an underlying medical condition.
Breathe Right Strips	Yes	No
Braille Books and Magazines	Yes	No
Braces	Yes	No	See Orthodontia
Breast Feeding Supplies	Yes	No	Breast 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 Surgery	Yes	No	Following a mastectomy for cancer.
Cancer Screenings	Yes	No
Cane/Walking Cane	Yes	No
Chinese Herbs and Supplements	Yes	Prescription	See "Who may write a Prescription" above.
Childbirth Classes	Yes	No	Only the portion of the class covering the birthing process.
Childbirth Hypnosis	Yes	Letter
Chiropractors	Yes	No
Christian Science Practitioners	Yes	No
Cholesterol Test Kits	Yes	No
Cold/Hot Pad/Patch	Yes	No
Copayment	Yes	No	Please refer to the instructions on the Medical Expense Reimbursement Claim Form.
Coinsurance and Deductibles	Yes	No	You must submit EOBs for these items to be reimbursed.
Colon Hydro Therapy	Yes	No
Compression Hosiery/Socks	Yes	No	May include diabetic socks
Concierge Medical Care	Potentially	No	The 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)	Yes	No
Contact Lenses, Materials and Supplies	Yes	No
Contraceptives	Yes	No
Cosmetic Procedures/Surgery	No	No
CPAP Device(s)	Yes	No	This includes replacement parts, repair and maintenance.
CPR Classes	See Details	Yes	CPR classes as part of birthing classes are reimbursable otherwise a letter of medical necessity is required
Crutches	Yes	No	The amount you pay to buy or rent crutches is eligible.
Day After Pill	Yes	No
Defibrillator	Yes	No	For personal use only. Commercial use items are not reimbursable.
Diabetic Socks	Yes	No
Diabetic Supplies (monitors, test kits, test strips and supplies)	Yes	No
Deductibles	Yes	No	You must submit EOBs for these items to be reimbursed.
Dental Care	Yes	No	For 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/Reconstruction	Yes	No
Dental Veneers	No	No
Doctor Visits	Yes	No	Provided they are not for unnecessary cosmetic surgery.
Doula (Birthing Coach)	Yes	Letter	For birthing services only. Delivery of child/child care is not reimbursable.
Drug Addiction	Yes	No	Inpatient treatment at a therapeutic center for drug addiction may be reimbursed. This includes meals and lodging at the center during treatment
Drugs	Yes	Prescription	Prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
Drug Testing	Yes	No
Durable Medical Equipment	Yes	Letter
Ear Plugs	Yes	Letter
Egg and Embryo Storage	Yes	Letter	Egg and Embryo Storage may not exceed 12 months.
Electrolysis	Yes	Letter	Only if directly related to treatment of an illness (mental or physical). Cosmetic procedures are not reimbursable.
Exercise Equipment or Programs	Yes	Letter	Recommended by physician to treat a specific medical condition.
Eyeglasses, Equipment and Materials including over-the-counter Reading Glasses	Yes	No	For medical reasons.
Eye Examinations	Yes	No
Eye Protection Plan	No	No
Eye Surgery	Yes	No	For eye surgery to treat defective vision, such as laser eye surgery or radial keratonomy.
Family Counseling	See Details	Yes	Family 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 Charges	No	No
First Aid Creams (eg: Bactine, Neosporin)	Yes	No
First Aid Kit	Yes	No	For personal use only. Commercial use items are not reimbursable.
Fertility Enhancement including ovulation and pregnancy tests	Yes	No
Fertility Treatments	Yes	No	Spouse only, not surrogate
Fiber Supplements (eg: Benefiber, Citrucel, Metamucil)	Yes	Prescription
Flex Plan Admin Fees	Yes	No	Admin 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 Shots	Yes	No
Food	Yes	No	The 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 Pads	Yes	No
Genetic Testing	See Details	Yes	If ordered for medical care. Not for paternity testing or to determine the sex of a child.
Glucosamine	Yes	Prescription
Glucose Monitoring Equipment	Yes	No
Group Therapy	See Details	Letter	See Family Counseling.
Guidedog or other Service Animal	Yes	Letter	The 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 or mental illness.
Hair Loss (eg: Rogaine, Propecia)	Yes	Letter	Only 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.
Head Lice Treatment (eg: Rid)	Yes	No	This applies to the medication only. Treatment mousse, shampoos and special combs must be prescribed (see "Who may write a Prescription" above). Time billed to remove lice is not reimbursable, unless performed by a licensed medical professional.
Hand Sanitizers,	Yes	No
HCG (Human chorionic gonadotropin injections)	Yes	Letter
Health Club Dues	Yes	Letter	If recommended by physician to treat a specific medical condition.
Hearing Aids, Devices and Batteries	Yes	No
Heart Monitor,	Yes	No	For personal use only. Commercial use items are not reimbursable.
Health Savings Accounts (HSA)	No	No
Hemmorrhoid Treatments (eg: Preparation H)	Yes	No
Herbs and Herbal Supplements (eg: Echinacea, Ginkgo, St John's Wort, Chinese)	Yes	Prescription	See "Who may write a Prescription" above.
Hippotherapy (therapeutic horseback riding)	Potentially	Letter	Recreational horseback riding is not an eligible expense.
Hormone Replacement Therapy (HRT)	See Details	Letter	Only if used to treat a medical condition.
Hospital Services	Yes	No	For legal operations that are not for unnecessary cosmetic surgery.
Hot/Cold Pad/Patch	Yes	No
Humidifier	Yes	Letter
Hypnosis	Yes	Letter	When 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.
Hypnobabies	Yes	Letter
Ibuprofen (eg: Advil, Motrin, Nuprin)	Yes	No
Immunizations	Yes	No
Incontinence Supplies	Yes	No	Catheter, Uninal, Bed Pan, Bed Cover, Mattress Protector
In-ear Monitor	Yes	Letter	Auditory 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 Insert	Yes	No
Insulin	Yes	No
Invisiline Braces	Yes	No	EOB from dental provider or statement of no dental insurance must accompany claim.
IPAP Device(s)	Yes	No	This includes replacement parts, repair and maintenance.
Ketamine	No	No	Ketamine used for the treatment of depression is not reimbursable. Ketamine is considered a controlled substance. Controlled substances in violation of federal law do not qualify for reimbursement even if a state law allows it.
Laboratory Fees	Yes	No
Lactation Consultant	Yes	Letter
Lactose Intolerance (eg: Lactaid),	Yes	No
Lap-band Surgery	Yes	No
Laser Hair Removal	No	Letter	Unless directly related to treatment of an illness (mental or physical). This item is under review in IRS Tax Court.
Lasik Eye Surgery	Yes	No
Laxatives (eg: Benefiber, Citrucel, Correctol, Ex-lax, Kaopectate, Metamucil, Milk of Magnesia	Yes	Prescription
Lifetime Care	No	No	Fees or advance payment for a retirement home or continuing care facility.
Liniments (eg: Bengay, Tiger Balm)	Yes	No
Long-term Care	Yes	No	"Qualified" Long-term insurance premiums as defined by IRS Publication 502 subject to the limits which adjust anually.
Marriage Counseling	No	No
Massage Therapy	Yes	Letter	Massages 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.
Magnetic Therapy	Yes	Letter
Maternity Clothes	No	No
Meals	Yes	No	The 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)	Yes	Letter
Medical Alert Programs (eg: Medical Guardian, Mobile Help, Life Alert)	Yes	Letter
Medical Equipment	Yes	No
Medical Record Charges	Yes	No
Medications	Yes	Prescription	Prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
Medicines	Yes	Prescription	Prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
Maternity Support Band	Yes	No
Midwife	Yes	No	Midwife must be licensed.
Mileage	Yes	Only if accompanied by receipt for doctor visit or RX	While seeking medical services or purchasing a RX, 2024 @ 21c/mile, 2023 @ 22c/mile
Missed Appointment Fees	No	No
Mold Removal (Household)	No	No
Mona Lisa Touch Laser Therapy	Yes	Letter
Morning After Pill	Yes	No
Motion Sickness Pills	Yes	No
Mounjaro	Yes	See details	With insurance payment Letter of Medical Necessity (LMN) not required. LMN required if there is no proof of insurance payment.
Nasal Sprays (eg: Afrin, Vicks, Neo-Synephrine)	Yes	No
Nasal Strips (eg: Breathe Clear, Breathe Right)	Yes	No
Nasal Wash/Rinse Systems (eg: Neti Pot, Navage)	Yes	Letter	Includes supplies
Naturopathic Healers	See Details	Letter	Expenses paid to alternative providers for naturopathic or holistic treatments or procedures are not covered unless to treat a specific medical condition.
Nebulizers, CPAP, BIPAP	Yes	No
Nursing Services	Yes	No	Services 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.
Nutritionist	See Details	Letter	When recommended by a health care professional for treatment of a specific medical condition.
Occlusal Guards (teeth night guards)	Yes	Prescription	The over-the-counter guards require a prescription. If the guard is acquired through your provider, a prescription is not required.
Occupational Therapy	Yes	No
Operations	Yes	No	For legal operations that are not for unnecessary cosmetic surgery.
Optometrist, Eyeglasses, Equipment and Materials	Yes	No	For medical reasons.
Orthodontia	Yes	No	EOB 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. Please note that the Plan may not reimburse forfuture services, total amount will be prorated. Billing must indicate the device type, eg: braces, clear aligners or invisiblebraces.
Orthopedic Inserts	Yes	No
Orthopedic Shoes	Yes	Letter
Oral Electrolytes (eg: Pedialyte)	Yes	No
Osteopath	Yes	No	For medical care.
Ovulation Monitor	Yes	No
Ovulation Test (over the counter)	Yes	No
Oxygen and Oxygen Equipment	Yes	No	To relieve breathing problems caused by a medical condition.
Ozempic	Yes	See details	With insurance payment Letter of Medical Necessity (LMN) not required. LMN required if there is no proof of insurance payment.
Pain Relievers (eg: Advil, Aleve, Excedrin, Motrin, Tylenol)	Yes	No
Parking	Yes	Only if accompanied by receipt for doctor visit or RX	While 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)	Yes	No	This applies to the medication only. See Head Lice Removal for more details.
Personal Protective Equipment (PPE)	Yes	No	PPE including certain masks, hand sanitizers, and hand sanitizing wipes may be eligible if used for the primary purpose of preventing the spread of COVID-19. Note: For expenses incurred 01/01/2020 and after. Important:This could change at any time if the CDC changes its guidelines for the prevention of COVID-19. Check here before submitting your claim.
Physical Examination and Diagnostic Tests	Yes	No	Performed by a physician.
Physical Therapy	Yes	No
Pilot's Headset	Yes	Letter	Headset designed and prescribed to prevent hearing loss in individuals working in environments which could cause hearing damage.
Placental Encapsulation	Yes	Letter
Pregnancy Aids (eg: Maternity Support Belts, Maternity Girdles)	Yes	No
Pregnancy Test (over the counter)	Yes	No
Pregnancy Test Kit	Yes	No
Prenatal Vitamins & Supplements	Yes	Letter	If taken during pregnancy.
Prescription Drug Discount Programs	No	No
Prescription Drugs (Rx)	Yes	Prescription	Prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.
Prosthesis	Yes	No
Psychiatrist and Phychiatric Care	Yes	No
Psychoanalysis	Yes	No	Provide that it is not part of required training to be a psychoanalyst.
Psychologist	Yes	No	Individual counseling/therapy is covered.
Radial Keratotomy	Yes	No
Reversal of Tubal Ligation or Vasectomy	Yes	No
Sales Tax on Qualified Medical Expenses	Yes	No	Sales tax will automatically be reimbursed if receipt is eligible for reimbursement.
Saxenda	Yes	See details	With insurance payment Letter of Medical Necessity (LMN) not required. LMN required if there is no proof of insurance payment.
Screening Tests	Yes	No
Shipping and Handling Fees for Eligible Expenses	Yes	No
Shoe Insert	Yes	No
Shower Chair	Yes	No
Sleep Aids (Sominex, Tylenol PM, Unisom)	Yes	No
Sleep Deprivation Treatment (eg: Breathe Right, NoDoz, Nytol, Sominex, Unisom)	Yes	No
Snake Bite Kit	Yes	No
Speech Therapy	Yes	No
Stem Cell, Harvesting and/or Storage	See Details	Letter	Collection 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.
Sterilization	Yes	No	A legally performed operation to make a person unable to have children.
Stop Smoking Programs	Yes	No	You 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 Drugs	See Details	No	Prescribed Drugs are reimbursable. Drugs that do not require a prescription, such as nicotine gum or patches, are not reimbursable.
Sunburn Creams (eg: Solarcaine)	Yes	No
Sunscreen, SPF 30+	Yes	No
Surgery	Yes	No	For legal operations that are not cosmetic.
Surrogate Related Charges, Fees and Expenses	No	No
Testosterone Replacement Therapy (TRT)	Yes	No
Teeth Bleaching/Whitening	No	No
Throat Lozenges or cough drops (eg: Chloraseptic, Cepacol, Halls, Ricola, Sucrets)	Yes	No
TNS Unit	Yes	No
Toothache or Teething Pain Relievers (eg: Orajel)	Yes	No
Tooth Brush and/or Toothpaste	No	No
Transplants	Yes	No
Transcranial Magnetic Stimulation (TMS)	Yes	Letter	Unless covered by insurance
Transgender Treatments/Surgery	Yes	No
Transportation and Travel Expenses for Person Receiving Medical Care	Yes	No	Transportation 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 Ligation	Yes	No
Umbilical Cord, Freezing and Storing of	See Details	Yes	Collection 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.
Vaccines	Yes	No
Vaginal Atrophy Treatment	Yes	Letter
Vaginal Rejuvenation Surgery	No	No
Varicose Veins, treatment of	Yes	No
Vasectomy	Yes	No
Veneers	No	No
Virtual Physical Body Scan	Yes	No
Vision Correction Surgery	Yes	No	For eye surgery to treat defective vision, such as laser eye surgery or radial keratonomy.
Vitamins & Supplements	Yes	Letter	Not reimburable for general well being. Must be for the treatment of a specific medical condition. See "Who may write a Prescription" above.
Walker	Yes	No
Wart Removal Treatment (eg: Compound W, Dr. Sholl's, Tinamed)	Yes	No
Weight-loss Programs and/or Drugs Prescribed to Induce Weight Loss	Yes	Letter	If 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.
Wegovy	Yes	See details	With insurance payment Letter of Medical Necessity (LMN) not required. LMN required if there is no proof of insurance payment.
Wheelchair/Autoette	Yes	No
Wig	Yes	Letter	If 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 Fees	Yes	No
Yoga Classes	Yes	Letter