Most Popular Questions
When is a Health Care expense eligible for reimbursement?
A health care expense is eligible for reimbursement when a covered service is rendered during the benefit period in which you are enrolled. This applies to expenses such as:
- A visit to a health care provider or a provider comes to your home
- A prescription is filled by a pharmacist (or the date of service indicated on your receipt if the fill date is not included)
- A piece of home medical equipment is delivered to your home
- You pay for an eligible over-the-counter product, such as bandages
- You pay for an eligible over-the-counter medicine, such as ibuprofen
There are a couple of exceptions to this rule:
- Orthodontia: Since there is often little direct relationship between when a person visits the orthodontist and when you pay for orthodontia, any orthodontia expenses paid within a benefit period are reimbursable regardless of the date of service. Please refer to our Orthodontia Quick Reference Guide for more information.
- Rented home medical equipment (HME): If your FEHB plan or your provider decides that it is more prudent to rent the equipment rather than purchase, you can submit a claim each month for your out-of-pocket expense.
Example: A participant has sleep apnea. Their physician writes an order for a Continuous Positive Airway Pressure (CPAP) unit to see if that will improve their sleep. The HME vendor delivers and installs the unit in the participant's home. The CPAP device is scheduled to be rented for six months. The HME company submits a claim every month to the participant's FEHB plan. When the participant receives their Explanation of Benefits, they submit that along with a completed FSAFEDS claim form for reimbursement.
In accordance with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that was signed on March 27, 2020, over-the-counter (OTC) medicines or drugs (e.g., acne treatments, allergy and cold medicines, antacids, etc.) are eligible for reimbursement from your Health Care FSA without a physician's prescription as of January 1, 2020. Any over-the-counter (OTC) medicines or drugs purchased prior to January 1, 2020 are only eligible for reimbursement with a physician's prescription. Any items used for general health or cosmetic purpose ARE NOT eligible.