Health Care FSA
What expenses are eligible for reimbursement only if medically necessary?
Some expenses are eligible for reimbursement only when a doctor or other licensed health care practitioner certifies that they are medically necessary. Your doctor's certification must indicate your specific medical disorder, the specific treatment needed, how this treatment will alleviate your medical condition, and the length of treatment required. Examples include:
- Air conditioners, central air, heaters, and humidifiers installed in your home for allergy relief
- Cosmetic surgery following an accident, disease or other surgery
- Home medical equipment (such as reclining chairs, bed boards, special mattress)
- Water fluoridation units
- Weight loss program for treatment of a specific disease (such as heart disease or diabetes), not including cost of food
- Wigs for hair loss due to chemotherapy or radiation treatment
FSAFEDS has a sample Letter of Medical Necessity (LMN) (PDF) that you and your health care provider can use. A personal letter from your provider will also suffice as long as it includes all the information necessary to determine medical necessity. Please note, if the treatment extends beyond the time period listed on the previous LMN, you need to submit a new LMN covering the new time period. You must also submit a new LMN each year that you participate in FSAFEDS - the length of time cannot be indefinite.
If the LMN does not contain all of the information listed below, your letter may be denied.
- Employee name and Social Security number or FSAFEDS ID number
- Patient name
- Diagnosis (specific medical condition or disorder)
- CPT code assigned to your diagnosis
- Specific treatment prescribed by the provider
- How the treatment will alleviate the condition
- Duration of the treatment
- Provider signature, license number, state and telephone number