Page 58 - 2022 Washington Nationals Flipbook

Eligible Expenses MEDICAL EQUIPMENT/SUPPLIES MEDICATIONS
Air Purification Equipment* Insulin
BABY/CHILD TO AGE 13 Arches and Orthotic Inserts Prescription Drugs
Lactation Consultant* Contraceptive Devices
Lead-Based Paint Removal Crutches, Walkers, Wheel Chairs OBSTETRICS
Special Formula* Exercise Equipment* Breast Pumps and Lactation Supplies
Tuition: Special School/Teacher for Hospital Beds* Doulas*
Disability or Learning Disability* Mattresses* Lamaze Class
Well Baby /Well Child Care Medic Alert Bracelet or Necklace OB/GYN Exams
Nebulizers OB/GYN Prepaid Maternity Fees
DENTAL Orthopedic Shoes* (reimbursable after date of birth)
Dental X-Rays Oxygen* Pre- and Postnatal Treatments
Dentures and Bridges Post-Mastectomy Clothing
Exams and Teeth Cleaning Prosthetics PRACTITIONERS
Extractions and Fillings Syringes Allergist
Oral Surgery Wigs* Chiropractor
Orthodontia Christian Science Practitioner
Periodontal Services MEDICAL PROCEDURES/SERVICES Dermatologist
Acupuncture Homeopath
EYES Alcohol and Drug/Substance Abuse Naturopath*
Eye Exams (inpatient treatment and outpatient care) Optometrist
Eyeglasses and Contact Lenses Ambulance Osteopath
Laser Eye Surgeries Fertility Enhancement and Treatment Physician
Prescription Sunglasses Hair Loss Treatment* Psychiatrist or Psychologist
Radial Keratotomy Hospital Services
Immunization THERAPY
HEARING In Vitro Fertilization Alcohol and Drug Addiction
Hearing Aids and Batteries Physical Examination Counseling (not marital or career)
Hearing Exams (not employment-related) Exercise Programs*
Reconstructive Surgery (due to a Hypnosis
LAB EXAMS/TESTS congenital defect, accident, or medical Massage*
Blood Tests and Metabolism Tests treatment) Occupational
Body Scans Service Animals Physical
Cardiograms Sterilization/Sterilization Reversal Smoking Cessation Programs*
Laboratory Fees Transplants (including organ donor) Speech
X-Rays Transportation* Weight Loss Programs*

HSA ELIGIBLE
Insurance Premiums
Long Term Care Premiums

Note: This list is not meant to be all-inclusive, as other expenses not specifically mentioned may also qualify. Also, expenses marked with an asterisk (*) are
“potentially eligible expenses” that require a Note of Medical Necessity from your health care provider to qualify for reimbursement. For additional information,
check your Summary Plan Document or contact your Plan Administrator.