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 with a prescription
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 (PDF) 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: Tim has sleep apnea. His physician writes an order for a Continuous Positive Airway Pressure (CPAP) unit to see if that will improve his sleep. The HME vendor delivers and installs the unit in Tim's home. The CPAP device is scheduled to be rented for six months. The HME company submits a claim every month to Tim's FEHB plan. When Tim receives his Explanation of Benefits, he submits that along with a completed FSAFEDS claim form for reimbursement.