Tel: 515-224-7545
HEALTHALLIANCE
BENEFIT PLAN
FAQ
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Acupuncture – Medical expenses paid for acupuncture are reimbursable.
Alcoholism and drug abuse – Medical expenses paid to a treatment center for alcohol or drug abuse are reimbursable. This includes meals and lodging provided by the center during treatment.
Ambulance – Medical expenses paid for ambulance service are reimbursable.
Artificial limb – Medical expenses paid for an artificial limb are reimbursable.
Artificial teeth – See medical aids.
Birth control pills and devices – Medical expenses paid for birth control pills and devices prescribed by a doctor are reimbursable.
Braille books and magazines – The amount by which the cost of Braille books and magazines for use by a visually impaired person exceeds the price for regular books and magazines is reimbursable.
Breast augmentation – Expenses related to breast augmentation (such as implants or injections) are not reimbursable because the procedure is cosmetic in nature. However, medical costs related to the removal of breast implants that are defective or are causing a medical problem are reimbursable.
Breast reduction – Medical expenses related to breast reduction surgery are reimbursable only if a physician substantiates that the procedure is medically necessary and not for cosmetic purposes (that is, to prevent or treat an illness or disease).
Breast pumps – Breast pumps and supplies that assist lactation are reimbursable.
Child care – Reimbursable through the Dependent Care Account.
Chiropractor – Expenses paid to a chiropractor for medical care are reimbursable.
Clinic – Medical expenses for treatment at a health clinic are reimbursable.
Coinsurance/Co-Pay amounts – Medical coinsurance, co-pay and deductible amounts are reimbursable.
Contact lenses – Reimbursable.
Cosmetic surgery – Medical expenses for cosmetic surgery are reimbursable if the surgery is necessary to improve a deformity arising from or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma or a disfiguring disease. However, medical expenses paid for other cosmetic surgery are not deductible medical expenses under Code Section 213 and thus are not reimbursable by a health FSA. This applies to any procedure that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. For example, face lifts, hair transplants, hair removal (electrolysis) and liposuction generally are not deductible. If there is a concern that a medical or dental surgery could be considered cosmetic, a doctor’s certification should be obtained explaining how the procedure meaningfully promotes the proper function of the body or prevents or treats an illness or disease. This will help to prove that the claim is reimbursable.
Crutches – Medical expenses paid to buy or rent crutches are reimbursable.
Dancing lessons, swimming lessons, etc – Dancing lessons, swimming lessons, etc., are not reimbursable even if they are recommended by a doctor.
Day care – Reimbursable.
Deductibles – Medical insurance deductibles and coinsurance amounts under the employer’s plan are reimbursable.
Dental treatment – Medical expenses for dental treatment are reimbursable. This includes fees paid to dentists for X-rays, fillings, braces, extractions, dentures, etc.
Dependent care expenses – Dependent care expenses are not reimbursable under a health FSA, but may be reimbursable under a Dependent Care FSA.
Diaper service – Payments for diapers or diaper services are not reimbursable unless they are needed to relieve the effects of a particular disease.
Drugs – See medicines.
Drug addiction – See alcoholism.
Ear piercing – Expenses for ear piercing are not reimbursable.
Electrolysis or hair removal – See cosmetic surgery.
Employment-related expenses – Employment-related expenses such as employment physicals are not reimbursable. (Note, however, that physical exams that are not employment-related are reimbursable.
Eyeglasses – Eye examinations, eyeglasses, equipment and materials are reimbursable.
Fertility – Medical expenses related to the treatment of infertility, including in vetro fertilization, are reimbursable.
Fitness programs – Fitness programs or physical therapy for general health are not reimbursable.
Flu Shots – Reimbursable.
Fluoridation device or services – Yes, if recommended by a dentist to prevent tooth decay.
Funeral expenses – Expenses for funerals are not reimbursable.
Group medical insurance – See insurance premiums.
Hair transplant – See cosmetic surgery.
Health club dues – Health club dues, YMCA dues or amounts paid for steam baths for general health or to relieve physical or mental discomfort not related to a particular medical condition are not reimbursable.
Healthy baby care – Reimbursable.
Hearing aids – Medical expenses for a hearing aid and batteries are reimbursable.
Hospital – Expenses incurred as a hospital in-patient or out-patient for laboratory, surgical and diagnostic services qualify as medical expenses.
Impotence or sexual inadequacy – Medical expenses related to the treatment of impotence are reimbursable if substantiated by a physician.
In vitro fertilization – Reimbursable.
Infertility – Reimbursable.
Insulin – The cost of insulin is reimbursable.
Insurance premiums – Premiums for any health plan other than the employer’s, including health plans maintained by the employer of an employee’s spouse or dependent, are not reimbursable.
Laboratory fees – Laboratory fees that are part of medical care are reimbursable.
Learning Disability – Tuition fees you pay to a special school for a child who has severe learning disabilities caused by mental or physical impairments are reimbursable. Your doctor must recommend that the child attend the school. You can also be reimbursed tutoring fees you pay on your doctor’s recommendation for the child’s tutoring by a teacher who is specially trained and qualified to work with children who have severe learning disabilities.
Laser eye surgery – Lasik is reimbursable.
Liposuction – See cosmetic surgery.
Marriage counseling – Expenses for marriage counseling services do not qualify as medical expenses. However, sexual inadequacy or incompatibility treatment is reimbursable if the treatment is provided by a psychiatrist.
Maternity clothes – Expenses for maternity clothes are not reimbursable.
Massage – Fees paid for massages are not reimbursable unless prescribed and substantiated by a physician to treat a physical defect or illness.
Medical aids – Medical aids such as false teeth, hearing aids, crutches and elastic hosiery are reimbursable. Only legal medical services are reimbursable. Amounts paid for illegal operations or treatments, Regardless of whether they are rendered by licensed or unlicensed practitioners, are not reimbursable.
Medicare Part A – The tax paid for Medicare Part A is not reimbursable.
Medicare Part B – Premiums paid for Medicare Part B are not reimbursable.
Medicines – Certain amounts paid for medicines and drugs are reimbursable. Expenditures for drugs that are for cosmetic purposes or are illegally purchased do not qualify.
Optometrist – See Vision Care.
Orthodontia – Expenses for orthodontic care are generally reimbursable, except care for cosmetic purposes.
Personal use items – Items that are ordinarily used for personal living and family purposes are not reimbursable unless they are used primarily to prevent or alleviate a physical or mental defect or illness. For example, the cost of a wig purchased at the advice of a physician for the mental health of a patient who has lost all of his or her hair from disease is reimbursable.
Physical exams – Physical exams are generally reimbursable, except for employment-related physicals.
Pre-existing conditions – Medical expenses not covered because of the plan’s pre-existing condition limitation are reimbursable.
Prescription drugs – See medicines.
Private hospital room – The extra cost of a private hospital room is reimbursable.
Prosthesis – Reimbursable.
Psychoanalysis – Expenses for psychoanalysis are reimbursable if provided for medical care and not just for the general improvement of mental health, relief of stress or personal enjoyment.
Psychologist – Expenses for psychological care are reimbursable.
Radial Keratotomy – Reimbursable. Corneal ring segments (removable plastic half-rings that correct vision) would also qualify. Reasonable and customary charges, amounts in excess of______. Medical expenses in excess of the plan’s reasonable and customary charges are reimbursable.
Retin-A – Reimbursable when prescribed by a physician for treatment of acne, but not wrinkles.
Sexual counseling – Expenses for counseling regarding sexual inadequacy or incompatibility are reimbursable if the counseling is provided to a husband and/or wife by a psychiatrist.
Smoking program – Reimbursable. Amounts paid for a stop-smoking program would qualify, as would amounts for prescribed drugs and over-the-counter drugs used to stop smoking.
Sterilization – The cost of a legal sterilization (a legally performed operation to make a person unable to have children) is reimbursable.
Substance abuse – See Alcoholism and drug abuse.
Therapy – Amounts paid for therapy received as medical treatment are reimbursable.
Vaccines – Expenses for vaccines are reimbursable.
Vasectomy Reversals – Medical expenses related to a vasectomy reversal are reimbursable.
Vasectomy – Medical expenses related to a vasectomy are reimbursable.
Vision care – Optometric services and medical expenses for eyeglasses and contact lenses needed for medical reasons are reimbursable. Eye exams and expenses for contact lens solutions are also reimbursable. However, premiums for contact lens replacement insurance are not reimbursable.
Vitamins – Only expenses for vitamins prescribed by a physician that are only available by prescription and are to treat a specific medical condition are reimbursable.
Weight loss program – The cost of a weight loss program for general health is not reimbursable even if a doctor prescribes the program. It is reimbursable if the weight loss program is recommended by a physician to treat an existing disease (such as obesity, heart disease or diabetes) and is not simply to improve general health. The costs of food associated with a weight-loss program would not qualify.
Well baby care – Reimbursable.
Wigs – See personal use items.
X-ray fees – Amounts paid for X-rays taken for medical reasons are reimbursable.
Bandages, Band-Aids, Blood sugar test kits and test strips, Blood pressure monitoring devices, Carpal tunnel wrist supports, Cold/hot packs for injuries, Condoms, Contact lens solution and cleaners, Crutches, Dentures and denture adhesives, Diabetic supplies, First-aid kits, Gauze pads, Incontinence supplies, Nicotine gum or patches, OTC shipping charges or sales tax, Ovulation kit, Pregnancy test kits, Reading glasses, Thermometers, Nasal strips Allergy medications, Antacids, Anti-diarrhea medications, Antihistamine, Anti-itch cream, Aspirin, Bactine, Ben Gay or products for muscle pain, Bug bite medication, Calamine lotion, Cold medicine, Cough drops, Cough syrups, Decongestants, Diaper rash ointments and creams, First aid cream, Heartburn medicines, Hemorrhoid cream, Hydrogen peroxide, Laxatives, Liquid adhesive for small cuts, Menstrual relief products, Motion sickness pills, Muscle and joint pain products, Nasal sprays, OTC shipping charges or sales tax, Pain relievers, Prenatal vitamins, Rubbing alcohol, Sinus medications, Spermicidal foam, Sunburn remedies, Suppositories, Throat lozenges, Toothache and teething pain relievers, Visine and other eye products, Wart removal treatments, Throat lozenges
Acne treatments
Dietary supplements
Ear plugs
Exercise equipment & programs
Fiber supplements
Glucosamine/chondroitin
Health club dues
Herbal supplements
Hormone therapies
Lactose intolerance pills
Medicated shampoo
Nasal sprays for snoring
Orthopedic shoes and inserts
Retin-A
Sleeping aids
St. John’s Wort
Sunscreen
Weight loss supplements