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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.

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Displaying expenses 61-75 of 107
Eligible? Additional Document Expense
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)
Not eligible Over-the-Counter medication (2019 Requires Prescription from your doctor)
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 Rx (prescription)
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Eligibility Legend
Symbol Description
= Eligible with a detailed receipt
= Not eligible
= Eligible with appropriate documentation:
Conditional Requirements Legend
Symbol Description
= Requires Prescription from your doctor, plus detailed receipt
= Requires letter of Medical Necessity signed by your doctor, plus detailed receipt