FLEXIBLE SPENDING ACCOUNT EXPENSES SUPPLEMENT

Transcription

1 Health Care FLEXIBLE SPENDING ACCOUNT EXPENSES SUPPLEMENT The Health Care Flexible Spending Account (HCFSA) helps you save money on eligible health care expenses that are not covered by your L-3-sponsored health care coverage or any other health care coverage you and/or your dependents have. The Account also helps you save on the cost of certain over-the-counter drugs and medicines. You can participate in the HCFSA even if you do not enroll in an L-3-sponsored Medical or Dental Plan. Eligible Health Care Expenses You can use the HCFSA to pay for the following: Eligible health care expenses that are not covered under or fully reimbursed by your L-3-sponsored health care coverage or any other health care coverage you may have The cost of eligible over-the-counter drugs and medicines that are for medical care, as described starting on page 10. You can participate in the HCFSA even if you do not enroll in L-3-sponsored health care coverage. In addition to unreimbursed expenses under the terms and conditions of your L-3-sponsored Health Care Program, you may submit expenses (such as deductibles, copays and coinsurance) you have through any other insurance plans under which you and/or your dependents are covered. For information on how the HCFSA works, see The Health Care Flexible Spending Account SPD booklet. If you have questions about what s considered an eligible expense under the HCFSA, please call WageWorks at The IRS considers the health care expenses shown below deductible for income tax purposes, which means they are reimbursable from your HCFSA. However, tax rules change; check with your tax advisor about the eligibility of specific expenses. The following is a partial list of eligible health care expenses; you can get complete details from IRS Publication 502, Medical and Dental Expenses, which is available from your local IRS office or on the Internal Revenue Service s website ( Be sure to review the Ineligible Health Care Expenses section, starting on page 8, or check with WageWorks the HCFSA Administrator to find out which health care expenses are not reimbursable from the HCFSA. Abortion (payments to obtain a legal abortion) Acupuncture (payments for acupuncture are eligible medical expenses when submitted with documentation supporting a specific medical condition) Adoption (medical expenses paid for your child before adoption, if the child qualified as your dependent when the services were provided or were paid) Air conditioning, air filter, purifier, humidifier (payments for these portable units when they are recommended by a physician as treatment for a specific medical condition, when submitted with documentation supporting a specific medical condition. If the value of your home increases, these payments are not reimbursable) Alcoholism (payments to a treatment center for alcohol or drug addiction, including meals and lodging provided by the center during medical treatment, and your transportation costs to attend Alcoholics Anonymous (AA) meetings recommended by the attending physician, when submitted with supporting documentation)

2 Ambulance service Anesthesiology Arch support (payments for arch supports, if prescribed by a physician as treatment and when submitted with documentation supporting a specific medical condition) Artificial insemination (see Fertility on page 3) Artificial limb (payments for the purchase of an artificial limb) Asthma equipment (payments for nebulizers or peak flow meters prescribed for treatment of asthma) Birth control (payments for the purchase of birth control prescribed by a doctor, e.g., IUD, diaphragm, Norplant ) Blood donation Braille books and magazines (payments for Braille books and magazines for use by visually impaired persons; eligible expenses include only the payments over the cost of the book or magazine in its standard form) Breast pump purchase or rental Breast reduction (payments of medical expenses related to breast reduction surgery, only if the physician substantiates that the procedure is medically necessary, i.e., to prevent or treat an illness or disease) Breast implant removal (payments for the removal of breast implants that are defective or are causing a medical problem) Capital expenses (payments for special equipment installed in your home for improvement if there is documentation from a physician that the equipment is mainly needed for or as a result of a specific medical condition) Car (payments for special hand controls and other special equipment installed in a car for use by a disabled person) Chiropody (payments to a chiropodist a chiropractic foot doctor for medical care, if there is documentation of a specific medical condition) Chiropractor (payments to a chiropractor, if there is documentation of a specific medical condition) Christian Science practitioner (payments to a Christian Science practitioner, when treatment is provided for a specific medical condition) Circumcision (payments for infant circumcision, which is also covered if performed in your home by a rabbi. Adult circumcision is covered only if it is performed for a specific medical reason) Collagen injections (payments for injections are covered if medically necessary, e.g., to treat severe acne) Contact lenses, solutions, supplies and warranties (payments, including shipping and handling, for the purchase of contact lenses, if contact lenses are needed for medical reasons. Payments for contact lens solutions and supplies, and for eye exams, are also eligible) Copays and coinsurance Cosmetic treatment (payments for cosmetic surgery necessary to improve a deformity arising from or directly related to a congenital abnormality, a personal injury or a disfiguring disease) 2

3 Counseling (payments for counseling, e.g., behavioral, marriage or pastoral counseling, for you or a family member with a medical condition. There must be documentation from a physician stating that counseling was prescribed and that it is medically necessary to treat a specific medical or mental condition) Deductibles Dental treatment (including payments to dentists for x-rays, fillings, braces, extractions, dentures, caps, crowns, fluoride treatment, implants, etc. In addition, payments for the installation and monthly rental for fluoride treatments to home water are eligible when prescribed by a physician or dentist. However, the amount should be limited to the cost that can be allocated only to the current Plan Year. See page 5 for special reimbursement rules that apply to orthodontia) Denturist (payments to a denturist for the treatment of a specific medical condition) Dermatology (payments to a dermatologist for medical care) Developmentally disabled special home for (payments for keeping a developmentally disabled person in a special home not the home of a relative on the recommendation of a psychiatrist, to help the person adjust from life in a mental hospital to community living) Diabetic equipment and supplies (payments for the following equipment and supplies for the treatment of diabetes: glucose monitor; urine and blood test strips; insulin and syringes; and alcohol swabs) Diagnostic services (payments for diagnostic services prescribed by a physician, except for general wellness screenings) Diapers and diaper service (payments for adult diapers or a diaper service, if prescribed by a physician to relieve the effects of a specific medical condition. Payments for diapers and diaper service for handicapped individuals beyond infancy are also eligible) Dietitian (payments to a dietitian, when referred by a physician for treatment of a specific medical condition) Drug addiction (see Alcoholism on page 1) Durable medical equipment (payments to purchase or rent durable medical equipment that is prescribed by a medical practitioner to alleviate or treat a specific medical condition. Durable medical equipment includes the following: bed wetting alarm; blood pressure kit; chair reimbursement is only for the amount that exceeds the cost of a similar or regular product; crutches; hearing aids; medical alert equipment; and oral hygiene equipment) Exercise equipment (payments for exercise equipment when prescribed by a physician as treatment for a specific medical condition) Experimental drugs (payments for experimental drugs, if they are obtained legally) Eyeglasses and related supplies such as a storage case, replacement cost, warranties (payments for prescription vision and sports eyewear, supplies, e.g., eyeglasses, goggles, sunglasses, required for a medical condition. Payments for tinting of prescription eyewear are also eligible) Fertility (payments for the treatment of infertility, including shots, in vitro fertilization and artificial insemination. Semen and embryo storage associated with an active attempt to conceive is also eligible for reimbursement. Donor expenses that you, your spouse or your covered dependent have, e.g., egg donation, sperm donation, are eligible during active treatment only, if expenses are not covered by a medical plan. The cost of an ovulation kit is also eligible if prescribed by a physician for infertility) Flu shot 3

4 Guide dog or animal (payments for a guide dog or other animal to be used by the visually impaired or hearing impaired, or trained to assist you with other physical disabilities. Payments for the care of these specially trained animals are also eligible) Gynecologists (payments to a gynecologist for medical care) Health club (dues payments for a health club, YMCA, YWCA or spa membership, when you submit documentation from your attending physician stating that the membership expenses are for treatment of a specific medical condition. Reimbursement should be only for the individual membership and for the component that is related to a single Plan Year. Any dues that carry over to a subsequent Plan Year are not eligible) Health screenings (see Diagnostic services on page 3) Holistic/homeopathy practitioner (payments to a holistic or homeopathy doctor, when treatment is provided for a specific medical condition) Hospital services (payments for hospital services that are not covered under a medical plan, e.g., upgrade from semiprivate to private room, payments for parents to stay with a child, etc. Also see Lodging and trips, below) Human guide (payments for a human guide, e.g., to take a blind child to school. Also, see Guide dog or animal, above) Hypnosis (payments for hypnosis, when prescribed by a physician as treatment for a specific medical or mental condition) Infertility treatments (see Fertility on page 3) Interplaque machine (see Durable medical equipment on page 3) Investigational surgery (payments for investigational surgery, when recommended or prescribed by a physician) In vitro fertilization (see Fertility on page 3) Laboratory fees (payments for laboratory charges that are part of your medical care) LASIK eye surgery (payments for LASIK/PRK or radial keratotomy surgery to correct impaired vision) Lead paint and asbestos removal (payments for removing lead-based paints and asbestos from surfaces in your home to prevent a child who has or has had lead poisoning from eating the paint. The cost of repainting is not eligible) Learning disability (see Schools special on page 6) Legal fees (payments for legal expenses to authorize treatment for a mentally ill patient) Lessons (payment for lessons, when submitted with supporting documentation from a physician that the lessons are necessary to treat a medical condition) Lodging and trips (payments for meals and lodging at a hospital or similar institution, if the main reason for being there is to receive medical care. Payments for transportation to another city are eligible if the trip is primarily for and essential to receiving medical services. You may also be eligible for reimbursement of up to $50 per person, per night for lodging see IRS Publication 502, Medical and Dental Expenses, for more information) 4

5 Marriage counseling (see Counseling on page 3) Massage therapy (payments for massage therapy are covered if you submit documentation from a physician confirming that massage therapy is prescribed as treatment of a specific medical condition. The documentation should include the frequency and duration of the therapy) Maternity charges prepaid (payments made in advance to physicians for anticipated delivery charges) Mattresses (payments for a mattress or special bedding for you, your spouse or your dependent, with documentation supporting a medical condition, but only for the amount that exceeds the cost of similar regular bedding. Proof of the cost of regular bedding is necessary) Meals (payments for meals associated with inpatient medical care) Medical plan information (payments for services to keep your medical information so that it can be retrieved from a computer data bank, and payments associated with copying medical records) Medical services (payments for eligible medical services to treat specific medical conditions by physicians, surgeons, specialists or other medical practitioners) Medicines (payments for prescribed medicines and drugs. A prescribed drug is one that requires a written order by a medical practitioner and is dispensed through a pharmacy for its use by you, your spouse or your dependents. Payments you make for delivery charges, postage and handling of mail-order prescribed drugs are eligible. Payments for over-thecounter medicines and supplies for medical care are also eligible; see page 10) Mouth guards (payments for occlusal guards prescribed by a dentist to prevent a person from grinding his or her teeth at night) Neurologist (payments to a neurologist for treatment of a specific condition) Nursing home (payments for the cost of medical care provided in a nursing home or home for the aged for you, your spouse or your dependents, including the cost of meals and lodging in the home if the main reason for being there is to receive medical care; a bill from a provider or facility for medical services is required) Nursing services (wages and other payments for nursing services, including services connected with caring for the patient s condition, such as dispensing medications, changing dressings, bathing and grooming the patient. Only payments for nursing services are eligible. If the attendant also provides personal and household services, these payments must be divided between the time spent performing household and personal services and the time spent for nursing services) Nutritional supplements (payments for special foods or nutritional supplements, if there is supporting documentation from a physician that they were prescribed as treatment for a specific medical condition) Optometrist (see Contact lenses on page 2 and Eyeglasses on page 3) Organ donor (payments for a donor s expenses, made by you) Orthodontia (payments for orthodontia services received in the current Plan Year, as well as upfront payments for future services, even if treatment will extend over more than one Plan Year) Orthopedic shoes (payments for special shoes, but only for the amount that exceeds the cost of regular footwear) Over-the-counter medications (see page 10) Oxygen (payments for oxygen or oxygen equipment to relieve breathing problems caused by a medical condition) 5

6 Parking (see Transportation on page 7) Pastoral counseling (see Counseling on page 3) Personal trainers (payments to personal trainers, if recommended by a medical practitioner to treat a specific medical condition) Personal use items (payments for personal use items used primarily to prevent or alleviate a physical or mental defect or illness, when accompanied by documentation supporting a specific medical condition, e.g., payment for a wig purchased upon the advice of a physician for the mental health of a patient who has lost all of his/her hair from disease) Physical therapy (payment for physical therapy is covered only if the member submits documentation from a physician confirming that physical therapy is prescribed as treatment for a specific medical condition and showing the frequency and duration of the therapy) Prescription drugs (see Medicines on page 5) Prosthesis (see Artificial limb on page 2) Psychiatric care (payments for psychiatric care, including payments associated with the care of you, your spouse or your dependents in a specially equipped medical center where the medical care is received, when prescribed by a physician) Psychoanalysis Psychologist (payments to a psychologist for medical care, when submitted with documentation supporting a specific medical condition) Reasonable and customary expenses (payments above the reasonable and customary or usual and customary charges for covered health care expenses) Schools special (payments to a special school for a mentally impaired or physically disabled spouse or dependent, if the main reason for using the school is its resources for relieving the disability. Payment can be for: teaching Braille to a visually impaired child; teaching lip reading to a hearing-impaired child; and giving remedial language training to correct a condition caused by a birth defect. The costs for meals, lodging and ordinary education supplied by a special school are eligible only if the main reason for the child being there is the resources the school has for relieving the disability) Special foods (see Nutritional supplements on page 5) Speech therapy (payments for speech therapy, when prescribed as treatment for a medical condition, e.g., autism or dyslexia) Sperm storage (payments for storage of sperm for treatment of infertility) Stem cell storage (payments for stem cell storage if storage is used to treat a specific medical condition. The cost to collect and freeze the stem cells is also eligible as long as a specific medical condition is present. The amount not covered under your medical plan coverage would also be eligible) Sterilization (payments for obtaining a legal sterilization or to reverse sterilization) Stop-smoking program (payments for the cost of a stop-smoking program; documentation of medical necessity is not required) Substance abuse (see Alcoholism on page 1) 6

7 Surrogate mother (payments for eligible medical expenses not covered under other medical insurance for you, your spouse or your dependents who fulfill the role of surrogate mother) Swim therapy (payments for swim therapy or a swim club membership when prescribed by a medical practitioner as treatment for a specific medical condition, e.g., rheumatoid arthritis) Taxes (payment of taxes for medical services or products, e.g., sales tax and state hospital bill surcharges) Telephone (payments for enhancing a telephone to accommodate a deaf person with disabilities) Telephone consultation physicians fees (payments to physicians for telephone consultations. The cost of the phone call is also eligible) Television (payments to modify a television to assist a handicapped person, including an adapter that attaches to a regular television. Also included may be payments for a specially equipped television. The amount eligible for reimbursement is the cost associated with the specialization that s more than the cost of a similar standard television model) Transplants (see Organ donor on page 5) Transportation (payments for transportation primarily for, and essential to, medical care, when submitted with documentation supporting a specific medical condition. Payments for the following are included: ambulance services; buses; car rentals; parking amounts; plane fare; taxi fare; tolls; and mileage driven in your car $0.19 per mile. Also covered are transportation expenses for a nurse who provides medical services to the patient who is traveling to get medical care and is unable to travel alone; and transportation expenses to see a mentally ill dependent, if the visits are recommended as a part of the treatment) Trips (see Lodging and trips on page 4) Tuition (payments for medical care included in the tuition for a college or private school, if the charges are separately stated in the bill provided by the school) Tutoring (payments made on a doctor s recommendation for a child s tutoring by a specialized teacher, with documentation supporting a specific medical condition) Umbilical cord blood (payments made for collection, freezing and storage of umbilical cord blood, as long as a medical condition is present) UVR treatments (payments for UVR treatment when recommended by a physician for a medical condition, e.g., chronic psoriasis) Vaccinations (payments for vaccinations or immunizations against disease) Varicose vein surgery (payments for the removal of varicose veins prescribed by a doctor for treatment of a specific medical condition) Vasectomy (payments for the medical costs for a legal vasectomy) Weight loss drugs (payments for prescriptions prescribed by a physician to treat a medical condition, e.g., morbid obesity, hypertension) Weight loss programs (payments for medical expenses for a weight loss program prescribed by a doctor for treatment of a specific medical condition, e.g., high blood pressure, heart disease. Reimbursement should be only for the program related to a single Plan Year. Documentation must be provided by the attending physician prescribing the weight loss program; the documentation must confirm that the program was medically necessary for a specific medical condition and not for general health enhancement) X-rays (payments for x-rays provided for medical care). 7

8 Ineligible Health Care Expenses Just as important as understanding which health care expenses are eligible for reimbursement through your HCFSA is knowing which health care expenses are not generally eligible, including the following: Birthing coach (see Doula, below) Bleaching (whitening) or bonding of teeth Breast implants or injections Childbirth classes (e.g., Lamaze classes) COBRA premiums Collagen injections for cosmetic purposes Costs to operate a specially equipped car, except as explained under Car on page 2 Counseling for family members to learn how to cope with a family member s illness CPR classes Dancing lessons DNA testing for paternal responsibility Doula (birthing assistant or coach for a woman in labor) Drugs associated with general weight loss Ear piercing or body piercing Educational classes to care for a newborn, to breast-feed, to cope with diabetes, etc. Elective cosmetic treatment directed at improving an individual s appearance and that does not meaningfully promote the proper functioning of the body or prevent or treat an illness or disease (e.g., breast augmentation, chemical electrolysis, face lift, hair transplant, liposuction, tattoo removal) Electrolysis Exercise equipment used to improve general health Founder s fee (see Lifetime care advance payments on page 9) Funeral expenses Health club dues, YMCA/YWCA dues, or steam baths for your general health or to relieve physical or mental discomfort not related to a particular medical condition Insurance premiums to purchase health care coverage, including COBRA and Medicare Parts A and B Lamaze classes (see Childbirth classes, above) 8

9 Late fees associated with payment of medical expenses Legal fees for guardianship or estate management, or to obtain a divorce Lessons not prescribed by a physician for treatment of a medical condition (e.g., clarinet lessons to correct malocclusion) Lifetime care advance payments or founder s fees paid monthly or as a lump sum under an agreement with a retirement home Lodging and trips or vacation taken for a change in environment, improvement of morale or general improvement of health, even if a physician recommends the trip or vacation Long-term disability premium payments Marijuana purchased or used under state laws for treatment of a medical condition Massage therapy for general health Maternity clothes Medical coverage premiums attached to a college tuition or private school bill Medical expenses for a surrogate mother who is not you, your spouse or your dependent; payments to an agency to search for a surrogate mother Medical expenses for domestic partners Medical expenses or any payments relating to the adoption process incurred before the beginning of adoption negotiations; medical expenses for an adopted baby s birth incurred by the birth mother Non-prescription contact lenses, eyeglasses and sunglasses Nursing home non-medical expenses Personal trainers, for the improvement of general health Physical exam for a caregiver Preservation of semen and embryo for future generations Sperm storage for non-medical reasons Swimming lessons to learn swimming fundamentals Travel to another city of your choosing to receive medical care Vacation (see Lodging and trips, above) Varicose vein surgery for cosmetic purposes Wellness screenings. 9

10 Eligible Over-the-counter Drug and Medicine Expenses You can also use a HCFSA to reimburse yourself tax-free for over-the-counter drugs and medicines that are for medical care (as defined in the Internal Revenue Code), provided you have a doctor s prescription specifying the name of the medication and how often it is to be used. This means that, with a doctor s prescription, you can use a HCFSA to pay for such over-the-counter medication as aspirin, allergy remedies, cold remedies and heartburn medicine, and save money in the process. However, you cannot use a HCFSA for over-the-counter items that are used merely to advance your general good health, such as vitamins and dietary supplements not prescribed by a physician. Please note: A doctor s prescription is required for over-the-counter medications only not for over-the-counter supplies such as bandages. Be sure to review the Ineligible Over-the-counter Drug and Medicine Expenses section, on page 11, or check with WageWorks the HCFSA Administrator to find out which over-the-counter drugs and medicines are not reimbursable from the HCFSA. Below is a partial list of eligible over-the-counter drug and medicine expenses reimbursable from the HCFSA. This list may be amended from time to time. Please log on to for the most up-to-date list of eligible over-the-counter drug and medicine expenses. Acne treatment Allergy relief, e.g., oral medications, nasal sprays, patches Analgesics, such as fever and pain reducers, e.g., aspirin, acetaminophen, ibuprofen Antacids and heartburn relief, e.g., Alka-Seltzer, Mylanta, milk of magnesia Antibiotic creams and ointments Anti-itch and hydrocortisone creams Arthritis pain relieving creams Cold medicines, including tablets, syrups, drops and lozenges Ear care, e.g., ear drops, ear wax removal, ear plugs Eye care, e.g., contact lens solution, lubricant eye drops, eye patches, reading glasses Family planning products, e.g., condoms, contraceptive creams, pregnancy test kits, ovulation predictor kits Feminine care for treatment of vaginal infections, progesterone cream, estrogen cream First aid, e.g., heat wraps (hot/cold packs), compresses, bandages, tape, gauze dressing, adhesive pads, Band-Aids, pain-relieving creams, rubbing alcohol Foot care for athletes foot treatment, e.g., nail and foot anti-fungal creams, arch and insole supports, callus removers Hemorrhoid preparations Home diagnostic tests or kits, e.g., blood pressure monitor and related equipment; cholesterol test equipment; diabetes equipment, including a glucose monitor and related equipment; colorectal test equipment; HIV test kit; urine test; thermometers 10

11 Incontinence products, e.g., Depend and Serenity pads Joint-support bandages and hosiery, e.g., knee supports, elbow supports Laxatives Motion sickness treatment, e.g., Dramamine, patches, bracelets Shampoo treatments for psoriasis, lice Smoking-cessation relief, e.g., patches, gum Stomach and digestive relief, e.g., Pepto-Bismol, Imodium, Colace, Lactaid Tooth and mouth pain relief, e.g., Orajel, Anbesol Urinary pain relief Vaporizers and humidifiers Wart removal medication. Ineligible Over-the-counter Drug and Medicine Expenses Just as important as understanding which over-the-counter drugs and medicines can be reimbursed through your HCFSA is knowing which over-the-counter drugs and medicines are not generally eligible, including the following: Cosmetics, e.g., makeup, lipstick, cotton swabs, cotton balls, baby oil Denture care, e.g., denture cleansers, denture adhesive creams Hair care, e.g., hair color, shampoo, conditioner, brushes, hair-loss products such as Rogaine Homeopathic medicines (however, homeopathic medicines prescribed at the direction of a physician are eligible if a physician s statement is provided) Nail care and personal grooming items, e.g., scissors, nail files Nutritional and dietary supplements, e.g., bars, milkshakes, power drinks, Pedialyte (however, supplements prescribed at the direction of a physician are eligible if a physician s statement is provided) Personal hygiene items, e.g., deodorant, soap, body powder, shaving cream and razors, feminine care and sanitary products Routine dental care products, e.g., toothpaste, toothbrushes, dental floss, mouthwashes (including antibacterial mouthwash and fluoride rinses), breath strips, teeth-whitening items Skin care, e.g., sun block, skin and body moisturizing lotion, lip balm Sleep aids, e.g., oral medications, snoring strips, stimulants (however, sleep aids prescribed at the direction of a physician are eligible if a physician s statement is provided) Vitamins (however, vitamins prescribed at the direction of a physician are eligible if a physician s statement is provided) Weight-reduction aids, e.g., Slimfast, appetite suppressants, water-retention products (however, weight-reduction products prescribed at the direction of a physician are eligible if a physician s statement is provided). 11