Page 89 - Texas Rangers 2022 Front Office Flipbook

ELIGIBLE GENERAL PURPOSE FSA EXPENSE LIST:

Items Typically Eligible Items Typically Ineligible

Acupuncture Cosmetic Procedures/Drugs of any nature
Alcoholism Treatment Programs Food Costs
Ambulance Services Hair Removal
Artificial Limbs Health Club Memberships
Birth Control Insurance Premiums
Braille Books and Magazines Marriage Counseling
Breast Pumps Medical Marijuana Use
Chiropractor Services
Christian Science Practitioners
Contact Lenses
Contact Lens Solution Items That Typically Require a Medical
Crutches/Canes Determination Letter to be Completed by a
Dental Services
Diagnostic Services Licensed Practitioner:
Drug Treatment Programs Alternative Medicines and Procedures
Eyeglasses/Exams Breast Reconstruction after mastectomy
Guide Dog Car Modifications
Hearing Aids (and batteries) Dietary Supplements
Hospital Services Dyslexia Treatments
Immunizations Exercise Equipment or Programs
Insulin Fitness Programs
Laboratory Services Home Improvements
Medical Services Lodging (as related to medical services provided)
Nursing Services Massage Therapy
Osteopathic Physician Services Orthopedic Shoes and Inserts
Over-the-Counter Items* Reconstructive Surgery (following accident /injury)
Over-the-Counter Medications** Special Schools (as applies to mental and physical disabilities)
Oxygen Swimming Lessons (as applies to treatment of medical
Prescription Drugs condition)
Psychiatric Services Special Class Tuition (as applied to specific medical condition)
Transplants Vitamins
Transportation for Eligible Services Rendered Weight Loss Programs (food excluded)
Wheelchairs
X-Rays
*A list of eligible over-the-counter items is available
**A list of eligible over-the-counter items that requires a prescription to accompany the request for
reimbursement is available
Please note that an expense is only considered eligible for FSA reimbursement if it is deemed medically
necessary to treat a specific medical condition, disease or diagnosis. A Letter of Medical Determination may be
requested at any time for additional clarification. This list is meant to be used as general guidance for eligible
FSA expenses and not meant to be all-encompassing.