*See last page for detailed explanation. 1
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1 Abortion Yes Artificial teeth Yes Acne treatment Aspirin Acupuncture Yes Asthma treatments Adoption pre-adoption medical expenses Yes Automobile modifications Air purifier Alcoholism treatment Yes Bandages for torn or injured skin (medicated or not) Yes Allergy medicine (Example: Alavert) Allergy treatment products; household improvements to treat allergies Alternative healers dietary substitutes and drugs and medicines Bactine Behavioral modification programs Birth-control pills Yes Blood pressure monitoring devices Yes Ambulance Yes Blood sugar test kits and test strips Yes Antacids (Example: Zantac) Antibiotic ointments (Example: Neosporin) Antihistamines (Example: Benadryl) Anti-itch creams (Example: Cortaid) Appearance improvements Calamine lotion Arthritis gloves Yes Capital expenses Artificial limbs Yes Car modifications Body scans Yes Braille books and magazines Yes Breast pumps Yes Breast reconstruction surgery following mastectomy Yes *See last page for detailed explanation. 1
2 Carpal tunnel wrist supports Yes Cosmetics Cayenne pepper Chelation therapy Yes Counseling Chinese herbal practitioners & herbal treatments Cough suppressants (Examples: Robitussin, cough drops) Crutches Yes Chiropractors Yes Decongestants (Example: Dimetapp) Chondroitin Claritin Deductibles Yes Dental sealants Yes Co-insurance amounts Yes Dental treatment Yes Cold medicine (Example: Sudafed) Dentures and denture adhesives Yes Cold/hot packs Yes Deodorant Cologne Diabetic supplies Yes Condoms Yes Diagnostic items/services Yes Contact lenses materials and equipment Yes Diaper rash ointments (Example: Desitin) Contraceptives Diapers or diaper service Controlled substances in violation of federal law Diarrhea medicine (Example: Pepto-Bismol) Co-payments Yes Dietary supplements Cosmetic procedures Diet foods *See last page for detailed explanation. 2
3 Disabled dependent care expenses DNA collection and storage Fever-reducing medications (Example: Tylenol) Fiber supplements Drug addiction treatment Yes First aid cream Drug overdose, treatment of Yes First aid kits Yes Drugs and medicines Dyslexia Fitness programs Flu shots Yes Ear piercing Fluoridation device or services Yes Ear plugs Founder's fee Egg donor fees Yes Funeral expenses Electrolysis or hair removal Gauze pads Yes Exercise equipment or programs Expectorants (Example: Comtrex) Eye drops (Example: Visine) Genetic testing GIFT (Gamete intrafallopian transfer) Yes Glucosamine Eye examination and eyeglasses Yes Glucose monitoring equipment Yes Face creams Hair colorants Face lifts Hair removal and transplants Feminine hygiene products Hand lotion Fertility treatments Yes Headache medications (Example: Advil) *See last page for detailed explanation. 3
4 Health club fees Insurance premiums Health institute fees IVF (in vitro fertilization) Yes Hearing aids Yes Laboratory fees Yes Hemorrhoid treatments (Example: Preparation H) Herbs Lactation consultant Lamaze classes Yes HMO premiums Language training Holistic or natural healers recommended drugs and medicines Home care Home improvements (such as exit ramps widening doorways etc.) Hormone replacement therapy (HRT) Laser eye surgery; Lasik Yes Late fees (e.g. for late payment of bills for medical services) Laxatives (Example: Ex-Lax) Lead-based paint removal Hospital services Yes Learning disability instructional fees Yes Humidifier Hypnosis Legal fees general Legal fees in connection with fertility treatments Illegal operations and treatments Lipsticks Immunizations Yes Liquid adhesive for small cuts Incontinence supplies Lodging at a hospital or similar institution Yes Infertility treatments Yes Lodging while attending a medical conference Insect bite creams and ointments (Example: Caladryl) Insulin Makeup Yes Marijuana or other controlled substances in violation of federal law *See last page for detailed explanation. 4
5 Massage therapy Missed appointment fees Mastectomy-related special bras Yes Moisturizers Maternity clothes Motion-sickness pills (Examples: Bonine Dramamine) Mattresses Mouthwash Meals not at a hospital or similar institution Nasal strips or sprays Meals of a companion Nasal saline Yes Meals while attending a medical conference Naturopathic healers dietary substitutes and drugs and medicines Medical alert bracelet or necklace Yes Nicotine gum or patches (Examples: Nicoderm, Nicorette) Medical information plan charges Yes n-prescription drugs and medicines Medical monitoring and testing devices Yes rplant insertion or removal Yes Medical newsletter Nursing services provided by a nurse or other attendant Medical records charges Yes Nursing services for a baby Medical services Yes Nutritionist's professional expenses Medicines and drugs Menstrual pain relievers (Example: Midol) Mentally handicapped special home for Mineral supplements Nutritional supplements Obstetrical expenses Yes Occlusal guards to prevent teeth grinding Yes One-a-day vitamins *See last page for detailed explanation. 5
6 Operations Yes Prescription drugs and medicines obtained from other countries Optometrist Yes Prescription drug discount programs Orthodontia Yes Preventive care screenings Yes Orthopedic shoes and inserts Propecia Osteopath fees Yes Prosthesis Yes Ovulation monitor Yes Psychiatric care Yes Oxygen Yes Psychoanalysis Pain relievers (Examples: Advil Aspirin Tylenol) Psychologist Patterning exercises Yes Radial keratotomy Yes Perfume Reading glasses Yes Permanent waves Recliner chairs Personal trainer fees Retin-A Physical exams Yes Rogaine Physical therapy Yes Rubbing alcohol Pregnancy test kits Yes Safety glasses Prenatal vitamins Schools and education residential Pre-payments Schools and education special Prescription drugs Screening tests Yes *See last page for detailed explanation. 6
7 Seeing-eye dog Yes Surgery Yes Shampoos Surrogate expenses Sinus medications (Example: Sudafed) Tanning salons and equipment Skin moisturizers Taxes on medical services and products Yes Sleep deprivation treatment Yes Teeth whitening Smoking cessation medications Telephone for hearing-impaired persons Yes Smoking cessation programs Yes Television for hearing-impaired persons Yes Soaps Thermometers Yes Spermicidal foam Sperm storage fees St. John's Wort Stem cell harvesting and/or storage of Throat lozenges (Examples: Cepacol, Chloraseptic) Toiletries Toothache and teething pain relievers (Example: Orajel) Toothbrushes Sterilization procedures Yes Toothpaste Student health fee Transplants Yes Sunglasses Sunburn creams and ointments (Example: Solarcaine) Transportation costs of disabled individual commuting to and from work Transportation expense primarily for and essential to medical care Yes *See last page for detailed explanation. 7
8 Treadmill Tuition for special needs program Usual and customary charges excess Yes Vitamins Vision correction procedures Yes Vision discount programs Vaccines Yes Walkers Yes Varicose veins treatment of Vasectomy Wart remover treatments (Example: Compound W) Yes Weight-loss programs and/or drugs prescribed to induce weight loss Vasectomy reversal Yes Wheelchair Yes Veneers Wigs Veterinary fees for Service Animals X-ray fees Yes Viagra Yes Yeast infection medications (Example: Monistat) Updated 3/22/2013 *See last page for detailed explanation. 8
9 Over-the-counter drugs and medicines are not reimbursable through your HSA unless prescribed by a medical practitioner. Dual purpose expenses, such as vitamins and supplements, are those that may be used to treat a medical condition, but may also be used to promote general health. Dual purpose expenses require: 1. A diagnosis of the medical condition by a medical professional, and; 2. A recommendation by the medical professional for the purchase of the particular item or service to treat the condition. For a more detailed health care expenses table please use your employee password to log in to the Allegiance website. Look in Tools & Support. 9
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