Eligible Expenses
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BABY/CHILD TO AGE 13
Lactation Consultant*
Lead-Based Paint Removal
Special Formula*
Tuition: Special School/Teacher for
Disability or Learning Disability*
Well Baby Care
DENTAL
Dental X-Rays
Dentures and Bridges
Exams and Teeth Cleaning
Extractions and Fillings
Gum Treatment
Oral Surgery
Orthodontia and Braces
EYES
Artificial Eyes
Eyeglasses and Contact Lenses
Laser Eye Surgeries
Prescription Sunglasses
Radial Keratotomy/LASIK
HEARING
Hearing Devices and Batteries
Hearing Examinations
LAB EXAMS/TESTS
Blood Tests and Metabolism Tests
Body Scans
Cardiographs
Laboratory Fees
Urine and Stool Analyses
X-Rays
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MEDICAL EQUIPMENT/SUPPLIES
Abdominal and Back Supports*
Air Purification Equipment*
Arches and Orthopedic Shoes
Contraceptive Devices
Crutches and Wheel Chairs
Exercise Equipment*
Hospital Beds
Mattresses*
Medic Alert Bracelet or Necklace
Nebulizers
Oxygen*
Post-Mastectomy Clothing
Prosthesis
Splints/Casts or Support Hose*
Syringes
Wigs*
MEDICAL PROCEDURES/SERVICES
Acupuncture
Alcohol and Drug Addiction (inpatient
and outpatient treatment
Ambulance
Hospital Services
Infertility Treatment
In Vitro Fertilization
Norplant Insertion or Removal
Physical Examination
(not employment-related)
Reconstructive Surgery (due to a
congenital defect or accident)
Service Animals*
Sterilization/Sterilization Reversal
Transplants (including organ donor)
Transportation*
Vaccinations and Immunizations
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MEDICATION
Birth Control
Homeopathic Medications*
Insulin
Prescription Drugs
Weight Loss Drugs*
OBSTETRICS
Lamaze Class
Midwife Expenses
OB/GYN Exams
OB/GYN Prepaid Maternity Fees
(reimbursable after date of birth)
Pre- and Postnatal Treatments
PRACTITIONERS
Allergist
Chiropractor
Christian Science Practitioner
Dermatologist
Homeopath or Naturopath*
Osteopath
Physician
Psychiatrist or Psychologist
THERAPY
Alcohol and Drug Addiction
Counseling (not marital or career)
Exercise*
Hypnosis
Massage*
Occupational
Physical
Speech
Weight Loss Programs*
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Note: This list is not meant to be all-inclusive, as other expenses not specifically mentioned may also qualify. Also, expenses marked with an asterisk (*) are “potentially eligible expenses” that require a Letter of Medical Necessity from your health care provider to qualify for reimbursement. For additional information, check your Summary Plan Document or contact your Plan Administrator.