Page 178 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

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;
• Expenses for medicines or drugs (including over-the-counter medicines and drugs that
do not require a prescription) or 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);
• Menstrual care products
• Personal protective equipment (such as masks, hand sanitizer and sanitizing wipes, for
the primary purpose of preventing the spread of COVID-19)
• 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;
• Certain long-term care expenses;
• Cosmetic surgery (except in limited circumstances);
• Electrolysis;
• Health club dues not related to a specific medical condition;
• Dental bonding and bleaching; and
• Weight loss (unless related to the treatment of a disease or other medical condition).

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