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What expenses are eligible for reimbursement only if medically necessary?

What expenses are eligible for reimbursement only if medically necessary?

Some expenses are eligible for reimbursement only when a doctor or other licensed health care practitioner certifies that they are medically necessary. Your doctor's certification must indicate your specific medical condition, description of recommended treatment, and the length of treatment required. Examples include:

  • Allergy treatments products (HEPA filters, Air purifier, etc.)
  • Cosmetic procedures or surgery (for birth defects, accidents, and/or disease)
  • Home medical equipment (such as reclining chairs, special mattress, humidifier, vaporizer)
  • Health club dues (as treatment for a medical condition diagnosed by a licensed health care professional)
  • Supplements (for treatment of medical condition)
  • Weight loss program (for treatment of a medical condition), not including cost of food
  • Wigs for hair loss due to chemotherapy or radiation treatment

FSAFEDS has a sample Letter of Medical Necessity (LMN) (PDF) that you and your health care provider can use. A personal letter from your provider will also suffice as long as it includes all the information necessary to determine medical necessity. Please note, if the treatment extends beyond the time period listed on the previous LMN, you need to submit a new LMN covering the new time period.

If the LMN does not contain all of the information listed below, your letter may be denied.

  1. Patient name
  2. Participant name
  3. Participant employer
  4. FSAFEDS username or last 4 digits of Social Security Number
  5. Medical condition
  6. Describe recommended treatment (frequency and dosage)
  7. Duration of the treatment
  8. Provider's name
  9. Provider's signature
  10. Date