HSA (Health Savings Accounts) Examples of Eligible Expenses

Your Health Savings Account may reimburse:
Qualified medical expenses incurred by the account beneficiary and his or her spouse and dependents;

· COBRA premiums;
· Health insurance premiums while receiving unemployment benefits;
· Qualified long-term care premiums*; and
· Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals age 65 or older.
Distributions made from an HSA to reimburse the account beneficiary for eligible expenses are excluded from gross income.

Qualified Medical Expenses:
The Internal Revenue Service defines qualified medical care expenses as amounts paid for the diagnosis, cure, or treatment of a disease, and for treatments affecting any part or function of the body. The expenses must be primarily to alleviate a physical or mental defect or illness.

The products and services listed below are examples of medical expenses eligible for payment under your Health Savings Account, when such services are not covered by your High Deductible Health Plan. To be an expense for medical care, the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness. This list is not all-inclusive; additional expenses may qualify, and the items listed below are subject to change in accordance with IRS regulations.

*Claims for over-the-counter medicine or drug expenses incurred during 2010 can be reimbursed without a prescription. Claims for over-the-counter medicine or drug expenses (other than insulin) that are incurred in 2011 cannot be reimbursed without a prescription. This new rule does not apply to items for medical care that are not medicines or drugs. Thus, equipment such as crutches, supplies such as bandages and diagnostic devices such as blood sugar test kits purchased after 2010 will still qualify for reimbursement without a prescription.

* For purposes of reimbursement of qualified long-term care premiums from an HSA, reimbursement in excess of the amount which may be deducted on an individual's personal tax return is not an eligible expense. IRS 213(d)(10) establishes the tax deduction allowed for qualified long-term care premiums on individual tax returns. If the HSA reimburses long-terms care premiums for an amount greater than set forth in IRC 213(d)(10), the amount greater than allowed is included in the account holder's taxable income and is subject to a 20% penalty in 2011.
· Abortion
· Acne treatment*
· Acupuncture
· Adoption (pre-adoption medical expenses)
· Air conditioner/purifier (if to treat medical condition)
· Alcoholism treatment
· Allergy medications*
· Alternative medicine (if to treat specific medical condition)
· Ambulance
· Analgesics*
· Antacid*
· Antibiotics
· Antihistamine*
· Anti-itch creams*
· Arthritis gloves
· Artificial limbs & teeth
· Aspirin*
· Asthma treatments
· Automobile modifications (if for physically handicapped person)
· Bactine*
· Bandages/Gauze
· Birth control pills
· Birthing classes
· Blood pressure monitoring devices
· Blood sugar test kit and test strips
· Blood storage (temporary storage for when collection is part of diagnosis, treatment or prevention of existing or imminent medical condition)
· Body scan
· Braille books/magazines
· Breast pumps (only if for medical condition)
· Breast reconstruction surgery following mastectomy
· Calamine lotion*
· Carpal tunnel wrist supports
· Capital expenses
· Cayenne pepper (only if treating specific medical condition)*
· Chelation therapy
· Christian Science practitioner fees
· Contraceptives
· Condoms
· Chiropractor
· Chondroitin/Glucosamine*
· Circumcision
· Co-insurance amounts and deductibles
· Cold medicine*
· Compression hose
· Contactlenses - also materials and equipment
· Copayments
· Cough suppressants*
· Counseling (except marriage)
· Crutches
· Decongestants*
· Deductibles
· Dental treatment (except teeth whitening)
· Dentures and denture adhesives
· Diabetic supplies
· Diagnostic items/services
· Diaper rash ointments/creams*
· Diarrhea medication*
· Disabled dependent care expenses
· Doula (only if providing medical care for mother/child)
· Drug addiction treatment
· Drug overdose, treatment of
· Ear plugs (for medical purposes)
· Ear wax removal products*
· Eczema treatments
· Egg donor fees
· Egg/Embryo storage fees (only for immediate conception)
· Exercise equipment/programs (only if required by physician)
· Expectorants*
· Eye drops
· Eye exams
· Eyeglasses, prescription
· Fertility/Infertility treatments
· Fiber supplements (only to treat medical condition)
· First aid cream
· First aid kits
· Flu shots
· Fluoridation device or services, rinses
· Food thickeners (if required by physician)
· Gambling disorder
· Genetic testing (only to diagnose medical condition)
· Glucose monitoring equipment
· Guide dog/other animal aid
· Health institute fees (only if prescribed by a physician)
· Hearing aids
· Hemorrhoid treatments*
· Home improvements to accommodate a disability
· Hormone replacement therapy (HRT)
· Hospital services
· Hot/cold packs
· Humidifier (if for specific medical condition)
· Hypnosis
· Inclinator
· Incontinence supplies
· Insect bite creams and ointments*
· Insulin
· IVF (in vitro fertilization)
· Laboratory fees
· Lactation consultant
· Language training (for dyslexia or disabled)
· Laser eye surgery/Lasik
· Laxatives*
· Lead-based paint removal
· Legal fees involving medical care
· Lodging at a hospital or similar institution
· Lodging not at a hospital or similar institution (up to $50/night; only if involving medical care)
· Lodging of a companion (if accompanying a patient for medical reasons)
· Masks, disposable (only if to treat specific medical condition)
· Massage therapy (only if recommended by a physician to treat a specific trauma or injury)
· Mastectomy-related undergarments
· Meals at a hospital
· Medical alert bracelet or necklace
· Medical conference admission, transportation, meals, etc. (if related to chronic condition suffered by you, spouse or dependent)
· Medical information plan charges
· Medical monitoring and testing devices
· Medical records charges
· Menstrual pain relievers
· "Morning after" contraceptive pills*
· Motion sickness pills*
· Nasal strips or sprays (only to treat sinus problems; not to prevent snoring)*
· Nicotine gum or patches*
· Norplant insertion or removal
· Nursing services provided by a nurse or attendant
· Nutritional supplements (only if they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician)
· Nutritionist's professional expenses (if treatment relates to specifically diagnosed medical condition)
· Obstetrical expenses
· Occlusal guard to prevent teeth grinding
· Optometrist
· Organ donors/transplants
· Orthodontia
· Orthopedic shoes/shoe inserts (only for treating specific medical condition)
· Osteopath fees
· Over-the-counter (OTC) drugs*
· Ovulation monitor
· Oxygen
· Pain relievers*
· Personal trainer fees (if for medical condition)
· Petroleum jelly (for medical condition)*
· Physical exams
· Physical therapy
· Pregnancy test kits
· Prenatal vitamins (only if taken during pregnancy)*
· Prescription drugs
· Preventive care screenings
· Probiotics (only for treatment of specific medical condition)
· Prostheses
· Psychiatric care
· Psychoanalysis
· Psychologist
· Radial keratotomy
· Reading glasses, prescription
· Rehydration solution
· Retin-A® (only if recommended by physician for specific condition)*
· Rubbing alcohol
· Screening tests
· Shipping/handling fees for medical item
· Sinus medications
· Sleep deprivation treatment
· Smoking cessation programs and medications
· Special education
· Special food required for diet by physician
· Special home costs for mentally handicapped
· Special medical equipment installed in a home
· Special TV/telephone equipment for hearing impaired
· Speech therapy
· Sperm storage (only for immediate conception)
· Spermicidal foam
· St. John's Wort (only if for diagnosed medical condition)*
· Stem cell harvesting and/or storage of (only if there is a specific and imminent medical condition the cells are intended to treat)
· Sterilization procedures
· Student health fee (not including the cost of belonging to the program)
· Sunglasses, prescription
· Sunburn cream/ointments*
· Support braces
· Surgery/Operations
· Taxes on medical services and products
· Therapy
· Thermometers
· Throat lozenges*
· Toothache/teething pain relievers*
· Transportation expenses for person to receive medical care
· Trips related to medical service
· Tuition for special needs program
· Ultrasound (prenatal - only to determine health or development; not for snapshots)
· Umbilical cord freezing/storage (only if there is a specific medical condition it is intended to treat)
· Usual and customary charges, excess
· Vaccines/Immunizations
· Vasectomy/Vasectomy reversal
· Vericose veins treatment (only if medically necessary)
· Veterinary fees (for the care of seeing- or hearing-impaired assistance animals)
· Viagra® (if prescribed by a physician)
· Weight loss program/drugs (if prescribed by a physician)
· Walkers
· Wart remover treatments*
· Wheelchair
· Wig
· X-ray fees
· Yeast infection medications*

Rev. 4/10, 11/10
Retin-A® is a registered trademark of Ortho Dermatologics. Viagra® is a registered trademark of Pfizer, Inc.
Plans that do not allow reimbursement of all eligible medical expenses as defined by the IRS and Department of Treasury must customize this brochure prior to use.
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