Page 143 - 2022 Washington Nationals Flipbook

MLB LWIP & Nationals Welfare
Plans and Summary Plan Description

expenses that you may deduct on your federal income tax return, although health insurance
premiums are not an eligible expense for the Health Care Reimbursement Account.
Medicines or drugs are eligible expenses only if such medicine or drug is a prescribed drug
(determined without regard to whether such drug is available without a prescription, but note
that the debit card cannot be used for over the counter drug expenses) or is insulin (unless
otherwise excluded). See Table 1 below for a list of some common eligible and ineligible
expenses. You will not be reimbursed for any expenses that are (i) not incurred in the Plan
Year, (ii) incurred before or after you are eligible to participate in the Plan, (iii) attributable
to a tax deduction you take in a prior taxable year, or (iv) covered, paid or reimbursed from
any other source.

Table 1: Expenses that Qualify for Reimbursement from a
Health Care Reimbursement Account

Eligible Expenses. The following list provides some examples of common expenses that can
be reimbursed from your Account:

 Deductibles and co-payments;
 Medical, dental, prescription drug and vision expenses not covered by any insurance

or a benefit plan;
 Over the counter medicines or drugs, only if the medicine or drug is a prescribed drug

(determined without regard to whether the medicine or drug is available without a
prescription) or is insulin. The Plan Administrator or its delegate shall have the sole
discretion to determine, on a uniform and consistent basis, whether a particular item
is a medicine or drug subject to this rule and whether the requirement of a
prescription has been satisfied;
 Ambulance fees;
 Chiropractic services;
 Oral contraceptives;
 Radial Keratotomy and Lasik surgery;
 Remedial reading classes for a child suffering from dyslexia;
 Hearing aids;
 Infertility services;
 Wheelchairs;
 Seeing-eye dog and its maintenance;
 Special school costs for physically or mentally disabled children;
 Smoking cessation programs;
 Weight loss programs (to the extent necessary for treatment of disease or other
medical condition);
 Prosthetics; and
 Durable medical equipment.

Ineligible Expenses. The following list provides some examples of common expenses that
cannot be reimbursed from your Account:

 Premiums for health insurance;

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