IBEW NECA Sound and Communications Trust Fund
Health Reimbursement Account (HRA):
What’s Eligible?
The IRS defines eligible health care expenses as amounts paid for the diagnosis, cure, mitigation or treatment of a
disease, and for treatments affecting any part or function of the body. The expenses must be primarily to alleviate a
physical or mental condition or illness. This list is not meant to be all-inclusive.
Eligible Expenses

Insurance Premiums and Interest (allowed for Long Term Care Premiums (allowed for HSA) PRACTIONERS
Over the Counter Medications (see reverse) MEDICAL TREATMENTS/PROCEDURES
Alcoholism and Drug Addiction (inpatient MEDICAL EQUIPMENT, SUPPLIES and
Physical Examination (not employment-related) Reconstructive Surgery (if medically necessary Learning Disability (special school/teacher) Weight Loss Programs (as prescribed by your Prescribed Medical and Exercise Equipment Splints/Casts or Support Hose (if medically OBSTETRIC SERVICES
Lamaze Class (child rearing classes excluded) Transportation Expenses (essential to medical OB/GYN Prepaid Maternity Fees (reimbursable Tuition Fee at Special School for Disabled Child Weight Loss Drugs (to treat specific disease) LAB EXAMS/TESTS
Ineligible Expenses
The IRS does not allow the following
expenses to be reimbursed. This list is
not meant to be all-inclusive.
Section 213d governs the eligible expenses
for HRA, FSA plans. Publications 502 and
503 are written to help taxpayers determine
what qualified expenses can be deducted on
their income tax returns FSAs and DCAP,
respectively. They should not be used as the
sole determinant for what is reimbursable
under these plans.
Over-The-Counter (OTC) Items
Effective January 1, 2012
Eligible OTC Medical Supplies: Itemized
Ineligible OTC Items:
receipt with claim request
Do not submit for
Adult incontinence products (e.g. Depends) reimbursement
Birth control products (e.g. prophylactics) Contact lens solutions Health monitors (e.g. blood pressure, cholesterol, HIV, thermometers) Supports/braces (e.g. ankle, knee, wrist, therapeutic glove) Please note that this is not a complete list, but is intended to provide Plan participants with
examples of OTC items that may be eligible.

OTC Drugs and Medicines Requiring a
Acne medications Allergy & sinus medications (Benadryl, Claritin, Sudafed) Anti-itch medications (Caladryl, Cortizone) Gastrointestinal aids (antacids, anti-diarrhea medicines, laxatives – non-fiber, nausea Nasal sprays for congestion (e.g. Afrin) Pain relievers (e.g. aspirin, Excedrin, Tylenol, Advil, Motrin) Please note that this is not a complete list, but
is intended to provide Plan participants with
examples of OTC items that may be eligible.
To be reimbursed for these expenses, a
completed claim form must be submitted to
Dual-Purpose Items: Itemized receipt and
UAS along with one of the following:
Certification of Medical Necessity form
A customer receipt identifying the
required with claim request
name of the person for whom the
prescription applies, the date and

amount of the purchase, and an Rx
number; or
A customer receipt that reflects the
purchase, along with a copy of the
Nasal strips & snore relief (e.g. Breathe Right) Vaporizers/humidifiers Vitamins/minerals/supplements


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Microsoft word - bebe stores inc - ppo 90 0 plan - caremark.docx

bebe stores, Inc. EPO 90/0 Plan Welcome to WellNet! The information below is a general description of your plan benefits and is not meant to be a complete list or complete description of available services. Please contact WellNet at 800-442-1101 with specific questions about your program. PRESCRIPTION DRUG COPAYS RETAIL (up to 30 day supply) MAIL SERVICE (up to 90 da

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