Encircled icon of a desktop computer monitorEncircled hand hold a mobile device on which the screen shows a check markArrow pointing leftArrow pointing rightAt symbol indicating an email addressInstitution IconMenu IconGo to first page symbolClosed book iconBookmark with tabsEncircled image of a handheld calculatorCalculator IconEncircled monthly calendarCalendar shaped box with checkmarkMonth view of a CalendarCaret DownCaret LeftCaret RightCheckmark on a circlular backgroundCheck mark in a square boxChild IconCircleClock faceClose or Cancel symbolThree cogs enmeshedComment bubbleComment bubbleTwo comment bubbles addressing each other in conversationIcon indicating a database as a stack of circlesEncircled image of a small hand laid atop a larger handDependent Care FSA IconDesktop computer monitor over a circle with a shadowDesktop computer iconEncicled open document folderMoney IconEncircled dollar signUS Dollar symbolDotted Arrow IconEdit IconGo to last page symbolPen with checked checkbox within a circleEnvelope IconExclamation Mark within a Triangular SignEncircled hand holding dollar billsEncircled compassEye IconFacebook LogoEdit IconStar IconFax IconEncircled hand holding a dollar signAdobe Acrobat PDF iconSingle, blank file iconTwo files in a stackLightning bolt symbolEncircled file iconA group of peopleEncircled white crossHealth Care Flexible Spending Account IconHeartbeat IconEncircled "i" characterText file icon symbolizing a paper letterEncircled image of two files, one laid above the otherEncircled icons of a tooth and an eyeLimited Expense Healthcase FSA IconEncircled lightbulbList IconLock IconEncircled megaphoneMedkit IconEncircled chat bubbleMobile phone over a circle with a shadowPause IconEncircled stack of coinsPhone IconPlay IconMouse Pointer IconPrescription SymbolPrinter IconQuestion Mark IconEncircled question markEncircled cloud with download symbolSearch IconSecure EmailSign In IconSign out of this siteSpinning circle indicating a process is activeEncircled starStar IconWrench within a circleTwitter LogoUser Icon with Plus SymbolDownload on the App StoreFSAFEDS LogoGet it on Google PlayUnited States Office of Personnel Management
Close Open Menu

Eligible Limited Expense Health Care FSA (LEX HCFSA) Expenses

Your Limited Expense Health Care FSA pays for qualifying dental and vision services and certain products.

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.

Currently showing 100 items per page. Activate to choose another option.
Displaying expenses 1-100 of 102
Eligible? Additional Document Expense
Not eligible Adoption fees
Not eligible Braille books and magazines (difference in cost only)
Not eligible Breastfeeding classes
Not eligible Child or newborn care instruction
Not eligible Cold cream (over-the-counter)
Eligible with a detailed receipt Contact lenses and solutions
Not eligible Cord blood storage (for unidentified future use)
Eligible with a detailed receipt Corneal keratotomy
Not eligible Cosmetic procedures or surgery
Not eligible Counseling (marriage)
Not eligible CPR classes (adult or child)
Eligible with a detailed receipt Dental
Eligible with a detailed receipt Dental (Co-insurance, Co-Payment and Deductible)
Eligible with a detailed receipt Dental (for non-cosmetic purposes)
Not eligible Dental products for general health
Eligible with appropriate documentation Requires letter of Medical Necessity signed by your doctor, plus detailed receipt Dental veneers
Not eligible Diapers and diaper services
Not eligible Doula or birthing coach
Not eligible Drugs (imported)
Not eligible Educational classes or tuition
Not eligible Electrolysis
Not eligible Emergency kits (over-the-counter)
Not eligible Exceed Plan Maximum
Not eligible Excessive Mileage
Eligible with appropriate documentation Requires Prescription from your doctor, plus detailed receipt Eye drops and treatments (over-the-counter)
Eligible with a detailed receipt Eye examinations
Eligible with a detailed receipt Eyeglasses (prescription)
Not eligible Face lifts
Not eligible Feminine hygiene products
Not eligible Fertility treatment (for non-dependent surrogate)
Not eligible Finance Charges
Not eligible Funeral expenses
Not eligible Hair regrowth products
Not eligible Hair removal
Not eligible Hair transplant
Not eligible Hand lotion (over-the-counter)
Not eligible Health club dues (as treatment for a medical condition diagnosed by a licensed health care professional)
Not eligible Herbal or homeopathic medicines (over-the-counter)
Not eligible Household help
Not eligible Hygiene Products (toothbrush, Feminine products, lotion, soap, etc.)
Not eligible Illegal operations or substances
Not eligible Insurance Payment/Adjustment
Not eligible Insurance Premiums
Eligible with a detailed receipt Invisalign and other clear aligners
Eligible with a detailed receipt Lasik
Not eligible Late payment fees charged by health care provider
Not eligible Magnetic therapy (over-the-counter)
Not eligible Maternity clothes
Not eligible Medical literature, books, pamphlets or audio
Not eligible Mileage (for travel to / from anything other than eligible care)
Eligible with a detailed receipt Mileage (for travel to/from eligible dental care)
Eligible with a detailed receipt Mileage (for travel to/from eligible vision care)
Not eligible Misc. Personal Use Items
Not eligible Missed Appointment Fee
Not eligible Nursing Home Care
Eligible with a detailed receipt Occlusal guards to prevent teeth grinding
Eligible with a detailed receipt Office visits (vision)
Eligible with a detailed receipt Optometrist / ophthalmologist fees
Not eligible Oral care (over-the-counter)
Eligible with a detailed receipt Ortho keratotomy
Eligible with a detailed receipt Orthodontia
Eligible with a detailed receipt Orthodontia (braces and retainers)
Eligible with a detailed receipt Payment Processing Fees
Not eligible Physician retainer fee (for on-call or concierge services)
Eligible with a detailed receipt Prescription Eyeglasses/ contact lenses
Not eligible Prescription(Co-insurance, Co-Payment, Deductible)
Not eligible Provider discount/coupon
Eligible with a detailed receipt Radial keratotomy (RK)
Eligible with a detailed receipt Reading glasses (over-the-counter)
Not eligible Rogaine or other hair regrowth medications (over-the-counter)
Not eligible Rx (prescription)
Eligible with a detailed receipt Sales tax, shipping and handling fees (for any eligible expense)
Not eligible Sunglasses (over-the-counter)
Eligible with a detailed receipt Sunglasses (prescription)
Not eligible Sunscreen with SPF <15 or suntan lotion (over-the-counter)
Not eligible Teeth bleaching or whitening
Eligible with a detailed receipt Teeth grinding prevention devices
Eligible with appropriate documentation Requires Prescription from your doctor, plus detailed receipt Toothache and teething pain reliever (over-the-counter)
Eligible with appropriate documentation Requires Prescription from your doctor, plus detailed receipt Toothpaste, medicated (difference in cost only of medicated toothpaste over the standard toothpaste)
Not eligible Toothpaste, toothbrush, floss, etc.
Not eligible Transportation, parking and related travel expenses, for non-eligible expenses
Eligible with a detailed receipt Transportation, parking and related travel expenses,for eligible expenses
Not eligible Tuition or educational classes
Not eligible Viagra and similar prescription medications
Eligible with a detailed receipt Vision
Eligible with a detailed receipt Vision - contact lenses solutions
Not eligible Vision - Prescription Goggles and Masks
Eligible with a detailed receipt Vision (Co-insurance, Co-Payment, Deductible) - Eligible
Eligible with a detailed receipt Vision Contact lenses case
Eligible with a detailed receipt Vision correction treatement/surgery
Eligible with a detailed receipt Vision Eye Patch
Eligible with a detailed receipt Vision: Ortho keratotomy/Orthokeratology
Eligible with a detailed receipt Vision: Eye Glass Repair Kit
Eligible with a detailed receipt Vision: Lens Wipes
Eligible with a detailed receipt Vision: Prescription Eyeglasses/ contact lenses
Not eligible Vitamins - General Health
Not eligible Vitamins - Prenatal
Not eligible Vitamins - Treatment of Medical Condition
Not eligible Warranties or other charges for future anticipated services (with none actually received)
Eligible with appropriate documentation Requires letter of Medical Necessity signed by your doctor, plus detailed receipt Waterpik flosser
Currently showing 100 items per page. Activate to choose another option.
Eligibility Legend
Symbol Description
Eligible with a detailed receipt = Eligible with a detailed receipt
Not eligible = Not eligible
Eligible with appropriate documentation = Eligible with appropriate documentation:
Conditional Requirements Legend
Symbol Description
Requires Prescription from your doctor, plus detailed receipt = Requires Prescription from your doctor, plus detailed receipt
Requires letter of Medical Necessity signed by your doctor, plus detailed receipt = Requires letter of Medical Necessity signed by your doctor, plus detailed receipt