Page 118 - 2022 MLB Benefit Guide 08.2022

02 What are Eligible Expenses?

The type of FSA you choose will determine what you can buy with the funds. Below are sample lists of potential
eligible expenses under each account. Refer to your plan highlights to verify whether an expense is eligible.

TYPES OF ELIGIBLE EXPENSES

• Medical FSA eligible expenses are qualified medical products and services and over-the-counter (OTC) drugs
and medicines (including dental and vision).

• Limited Purpose FSA eligible expenses are qualified dental and vision expenses.
• Dependent Care FSA eligible expenses are qualified child day care, nursery school and/or adult day care expenses.

Always check your plan highlights to verify if an item is eligible under your plan. To determine if an OTC drug or medicine
requires a prescription, or to search for more eligible items, visit BenefitResource.com/eligibilitylist.

MEDICAL FSA • Laser eye surgery, LASIK
EXPENSES • Lodging at hospital or similar institution OTC ITEMS
• Mastectomy-related special bras
• Medical alert bracelet or necklace
A-G • Medical information plan charges • Adult incontinence products
• Birth control products (e.g. prophylactics)
• Medical monitoring and testing devices
• Acupuncture (e.g. blood-sugar test kits) (if allowed by your plan)
• Alcoholism treatment • Medical practitioner’s fee for online or • Dentures and denture adhesives
• Allergy treatments (if prescribed) telephone consultation • First aid kits and supplies (e.g. bandages)
• Ambulance • Medical records charges • Health monitors (e.g. blood pressure,
• Asthma devices and medicines • Midwife cholesterol, HIV)
(if prescribed) • Heat wraps
• Bandages • Obstetrical expenses • Heating pads, hot water bottles
• Body scans • Occlusal guards to prevent teeth grinding • Medicine dropper/spoon
• Braille books and magazines • Operations/surgeries • Motion sickness devices
• Breast pumps • Optometrist • Supports/braces (e.g. ankle, knee,
• Breast reconstruction surgery following • Organ donors wrist, therapeutic glove)
mastectomy • Orthopedic shoe inserts
• Cancer screenings • Osteopath fees
• Carpal tunnel wrist supports • Ovulation monitor
• Chiropractors • Oxygen
• Circumcision • Physical exams LIMITED PURPOSE
• Coinsurance amounts • Physical therapy
• Copayments • Pregnancy test kits FSA EXPENSES
• Counseling, when used to treat diagnosed • Prescription drugs and medicines,
medical condition for the purpose of medical care • Correction procedures
• CPAP (continuous positive airway (not general health or cosmetic purposes) • Dental services and procedures
pressure) devices • Preventive care screenings • Eye examinations
• Crutches • Prosthesis and artificial limbs • Eyeglasses
• Dental sealants • Psychiatric care • Fluoridation services
• Dental services and procedures • Laser eye surgery, LASIK
• Diabetic supplies and insulin • Orthodontia
• Diagnostic items/services R-Z • Vision materials (e.g. contact solution)
• Drug addiction treatment
• Drug overdose, treatment of • Radial keratotomy
• Durable medical equipment • Rehydration solution
• Eye examinations, eyeglasses, vision materials • Screening tests (including cancer screening)
(e.g. contact solution), correction procedures • Sleep-deprivation treatment
• Flu shots • Speech therapy DEPENDENT CARE
• Fluoridation services • Stop-smoking programs FSA EXPENSES
• Guide dog • Transplants
• Transportation expenses for person • Before/after school care
H-Q to receive medical care • Child care
• Vaccines and immunizations • In-home dependent care
• Hearing aids and equipment for hearing- • Walkers/Wheelchair
impaired persons • X-ray fees • Day care facility
• Hospital services • Nursery school
• Laboratory fees • Adult care
• Lactation consultant