Microsoft word - otcfsaexpenses.doc
Over-the-Counter Flexible Spending Account Expenses
This is a general overview and is not a guarantee of reimbursement or eligibility. You are advised to review your
company’s FSA Summary Plan Description and enrol ment materials for specific information or consult with a tax advisor.
A Health Care FSA can only be used for expenses incurred for medical care under IRS Code Section 213 if other requirements in the
Code (including those in Prop. Treas. Reg. 1.125-2, Q/A-7 for claims substantiation, etc.) are also met. The rules change periodical y
due to new IRS guidance and this information is subject to change at any time without notice.
Eligible Expenses Examples
Sucrets and other throat lozenges, Bactine and its equivalents, Aspercreme and other topical anesthetics.
Femstat, Gyne-Lotrimin, Lotrimin, Micatin, Monistat, etc., and their generic equivalents.
EZ Scrub and similar disinfectants used on the body only. Antibacterial soap is not included.
Caldecort, Cort-aid, Hydorcortisone, Lanacort, etc., and their generic equivalents.
Benadryl, Claritin, Al erest, Chlor-Trimeton, Dimetane, Sudafed Plus, Tavist, Triaminic, Drixoral, Actifed,
etc., and their generic equivalents. Ivy Block for poison ivy. Nasalcrom and similar antihistamine nasal
Afrin, Chlor-Trimeton, Duration, Dristan, Neo-Synephrine, Orrivin, Sudafed, Triaminic, etc., and their
Home-based kits for pregnancy, blood glucose for diabetics and similar test kits.
Contraceptives, pregnancy testing kits and ovulation testing kits.
Fluorigard, ACT and other fluoride rinses, GelKam gel, StanCare.
Preparation H, Plazo and similar treatments.
Actron, Advil, Aleve, Motrin, Nuprin, Orudis, Tylenol etc., and their generic equivalents.
Pin-X, EZScrub, and other such items for intestinal worms, ringworm etc.
Unisom, Sominex, Excedrin PM, Nyquil, etc., and their generic equivalents.
Bandages, Ben-Gay and similar medication. Other items used to treat sprains and strains.
Medications used to treat heartburn, upset stomach, constipation, diarrhea etc., - AXID, Imodium, Pepcid,
Pepto-Bismol, Prilosec, Tagamet, etc., and their generic equivalents. Enemas, Ex-Lax and other laxatives.
Contact lens solutions, reading glasses, eye drops such as Visine and Ocuclear.
Antibiotic creams, Bactine, band-aids, and other “first aid” wound care treatments.
Claims submitted for these items must be accompanied by a doctor’s note.
Clearasil, Stridex, sodium sulfocetamide, benzoyl peroxide products and similar treatments. Facials,
aesthetician treatments, etc., and skin care treatments.
If they are for treatment of active anemia.
If they are for treatment of osteoporosis.
Perfumes, make-up, etc., even when the make-up is to cover scarring or other skin damage.
Drug use diagnostic kits are not eligible.
Wrinkle creams, Retin-A and similar items, moisturizers, etc.
Deodorant, soaps, shampoo, toothpaste and mouthwash, for which the participant would need to purchase
Any vitamins, supplements, fiber supplements or similar preparations used for general health.
Anything not used to treat a specific health condition. “Stockpiling”, purchasing large quantities of the
For more information please cal TRI-AD’s customer service at 888-844-1372.
Soft Tissue Augmentation with Fillers Restylane®, Perlane®, Juvéderm® Appointment Time: ____________________________ Pre-treatment Instructions Congratulations on your decision to have soft tissue augmentation (fillers). Your appointment will take 30-60 minutes. Plan to arrive on time and we will do our best to keep to your schedule as well as ours. We are looking forward t
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