ut flex even pays for your sunscreen.

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1 ut flex even pays for your sunscreen. (Insert #eyeroll here.) 1

2 really, it does pay for your sunscreen and so much more. You can use your UT FLEX debit card to pay for almost anything on this list that is ELIGIBLE. If for some reason a provider can t accept your debit card or you forget it at home, you have the following two options: 1. Pay Me. You pay your provider out of pocket, then go to our Maestro Health msave Mobile App and submit a photo of your receipt / invoice. If you re signed up for direct deposit via myutflex.com, you ll be paid faster than you can say Flexible Spending Account. 2. Pay Them. You can pay your provider through our Maestro Health msave Mobile App (or myutflex.com), then we take care of the rest. Acupuncture Adoption (related medical expenses) Adoption fees Alcoholism treatment Allergy products (available by prescription or over-the-counter) Alternative dietary substitutes Alternative drugs and medicines Alternative healers Ambulance Aspirin Birth control Birth control pills Body scans Braille books and magazines (difference in cost only) Child or newborn care instruction Childbirth classes Chiropractic treatment Chiropractor (office visit) Christian Science practitioners Co-insurance (medical, dental or vision) Condoms and spermicides Contact lenses, cleaning solutions, etc. Contraceptives (over-the-counter) Co-payments (medical, dental or vision) Cord blood storage (for future treatment of a birth defect) ** - A Letter of Medical Necessity (LOMN) may be necessary for expenses like this. Cord blood storage (for unidentified future use) Corneal Keratotomy Cosmetic surgery Counseling (for treatment of a medical condition) Counseling ( related) Crutches (purchase or rental) Dancing lessons (for treatment of a Deductibles (medical, dental or vision) Dental products (excluding general health items) Dental treatments Dental veneers Diagnostic services Drug addiction treatment Drugs (prescription) Dyslexia treatment Electrolysis Exercise equipment (for treatment of a Eye examinations Eye related equipment/materials Eyeglasses (over-the-counter) Eyeglasses (prescription) Facelifts Fertility monitor Fertility treatment (for employee, spouse or dependent) ** - A LOMN may be necessary for expenses like this. 2

3 Fertility treatment (for non-dependent surrogate) Fitness programs Flu shots Funeral expenses Guide dog (dog, training, care) Hair removal Hair transplant Health club dues Hearing aids and batteries Herbal treatments (non-prescription) Hospital services Household help Illegal operations Illegal substances Immunizations Infertility treatment (for employee, spouse or dependent) Insulin Insulin testing materials and equipment Insurance premiums Laboratory fees Lamaze classes Laser eye surgery Lasik Learning disability treatments ** - A LOMN may be necessary for expenses like this. Lodging (essential to receive medical care) Long-term care services Marriage counseling Massage therapy (for treatment of a Mastectomy-related special bras Maternity clothes Medical equipment (for treatment of a and repairs Medical monitoring and testing devices Medical records charges Medical savings accounts Medical supplies (for treatment of a Medicines (over-the-counter) Medicines (prescription) Modified equipment n-prescription drugs and medicines rplant insertion or removal Nursing services (wages and taxes) Nutritional supplements (for treatment of a OB/GYN fees Occlusal guards to prevent teeth grinding Office visits (medical, dental or vision) Operations (excluding cosmetic) ** - A LOMN may be necessary for expenses like this. 3

4 Optometrist / Ophthalmologist fees Organ transplants (recipient and donor) Ortho Keratotomy Orthodontia (adult or child) Over-the-counter medication Oxygen Personal use items (toothbrush, toothpaste, etc.) Physical exams Physical Therapy Pregnancy yoga Premiums (health plan or insurance) Prescription drugs Prosthesis Psychiatric care Psychoanalysis Psychologist fees Radial Keratotomy (RK) Reading glasses Reconstructive surgery following mastectomy Removal of benign mole, cyst or tumor Retin-A (excluding cosmetic uses) Rogaine Smoking cessation (programs / counseling) Smoking cessation drugs (prescription) ** - A LOMN may be necessary for expenses like this. Special equipment Special foods (e.g., gluten-free or saltfree diet) Speech therapy Sterilization Student health fees (for medical services) Sunscreen (SPF 30 or higher) Sunglasses (over-the-counter) Sunglasses (prescription) Supplies (for treatment of a medical condition) Surgery (cosmetic) Surgery (excluding cosmetic) Swimming lessons (for treatment) Teeth bleaching or whitening Therapy (for treatment of a medical condition) Toothpaste, toothbrush, floss Transgender treatments / surgery Transportation, parking and related travel expenses (essential to receive medical care) Tubal ligation UV protection clothing Vaccinations Varicose veins surgery Vasectomy Viagra (prescription) ** - A LOMN may be necessary for expenses like this. 4

5 Vitamins (over-the-counter) Providing Proof of Expense Vitamins (prescription) Weight loss counseling Weight loss foods Weight loss program (to improve or maintain general health) Weight loss program and / or drugs (for treatment of a Wheelchair and repairs X-ray fees ** - A LOMN may be necessary for expenses like this. Whether you swipe your debit card or file an online claim for reimbursement, Maestro Health needs to see certain types of documentation before the payment can be approved. Here are some examples of what is appropriate for different expense types: Pharmacy receipt for prescriptions and other pharmacy purchases Doctor s office receipt for office visit Explanation of Benefits (EOB) from your insurance or health plan for covered medical and dental expenses Bill or invoice from doctor or dentist for expenses not covered by your insurance or health plan Payment contract, monthly payment coupon or statement from your orthodontist Receipt from your optometrist or other medical service provider 5

6 dependent care Child Care Expenses After-school programs Babysitting (in someone else s home) Babysitting (in your home) Before-school programs Child care Dance lessons Educational services (other than preschool) Kindergarten Language classes Nursery school Piano lessons Preschool Private school tuition (for kindergarten and up) Sick child care Sleep-away camp Summer day camp Transportation to and from eligible care Tutoring Elder Care Expenses Adult day care Day nursing care Elder care (in your home) Medical care Nursing home care Senior day care Transportation to and from eligible care?? UT FLEX Dependent Care expenses work a little differently. You can t pay for these with your UT FLEX debit card. You pay for these the following two ways: 1. Pay Me. You pay your dependent care provider out of pocket, then go to our Maestro Health msave Mobile App and submit a photo of your receipt / invoice. If you re signed up for direct deposit via myutflex.com, you ll be paid faster than you can say Flexible Spending Account. 2. Pay Them. You can pay your dependent care provider through our Maestro Health msave Mobile App (or myutflex. com), then we take care of the rest. Proof of Expense You must provide proof for each expense listed on your claim form. Your proof should be appropriate for the type of expense: Your provider s signature in the designated area on your claim form Formal or informal statement or bill from your provider 6 p

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