Various Eligible Expenses
You can use your Limited Expense Health Care FSA (LEX HCFSA) funds to pay for a variety of dental and vision care products and services for you, your spouse, and your dependents. The IRS determines which expenses can be reimbursed by an FSA.
Keep Your Receipts
Please save your receipts and other supporting documentation related to your LEX HCFSA expenses and claims. The IRS may request itemized receipts to verify the eligibility of your expenses. Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.
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Displaying expenses 101-103 of 103
| Eligible? | Additional Document | Expense |
|---|---|---|
| Eligible with appropriate documentation | Requires letter of Medical Necessity signed by your doctor, plus detailed receipt | Waterpik flosser |
| Not eligible | Weight loss foods | |
| Not eligible | Weight loss program (to improve or maintain general health) |
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| Symbol | Description | |
|---|---|---|
| = | Eligible with a detailed receipt | |
| = | Not eligible | |
| = | Eligible with appropriate documentation: |
| Symbol | Description | |
|---|---|---|
| = | Requires Prescription from your doctor, plus detailed receipt | |
| = | Requires letter of Medical Necessity signed by your doctor, plus detailed receipt |