Affinity Group Underwriters


HSA Eligible Medical Expenses

	These may include, but are not limited to:

	Acupuncture Alcohol and drug rehabilitation Ambulance Anesthetist Artificial limbs and teeth Birth control pills Certain corrective surgery Chiropractor Christian Science practitioners Dental care Eye exam, eyeglasses, contact lenses, contact lens solutions and enzyme Gynecologist Hearing aids and batteries Hospital and skilled nursing facility Insulin Laboratory fees Laser Eye Surgery Lip-reading lessons Massage for Medical Reasons* Medical Examinations Midwife Nursing care Obstetrics Optometrist Orthodontia expenses as treatment is provided Osteopath Outpatient care Pediatrician Physical therapy provided by licensed therapist Physician Podiatrist Practical nurse Prescription drugs and some over the counter medicines Psychiatrist Psychologist Rental or purchase of medical equipment Stop-smoking program Supportive or corrective devices Surgery Transportation expenses relative to illness based on IRS standard mileage allowance Weight loss program for obesity*
	* You will be required to submit a doctor's’s statement outlining the medical necessity in order to claim these types of expenses
Top
	Examples of Over-The-Counter eligible expenses under an HSA may include, but are not limited to:

	Allergy Medicine Antacids Bactine Bandaids/Bandages Anti-Diarrhea Medicine Bug Bite Medication Calamine Lotion Carpal Tunnel Wrist Supports Cold Medicines Cold/Hot Packs for Injuries Condoms Contact Lens Cleaning Solution Cough Drops Diaper Rash Ointments First Aid Kits Hemorrhoid Medication Incontinence Supplies Laxatives Liquid Adhesive for Small Cuts Menstrual Cycle Products for Pain and Cramp Relief Motion Sickness Pills Nasal Sinus Sprays Nasal Strips Nicotine Gum or Patches for Stop-Smoking Purposes Pain Reliever Pedialyte for Ill Child’s Dehydration Pregnancy Test Kits Products for Muscle Pain or Joint Pain, i.e., BenGay, Tiger Balm, etc. Reading Glasses Rubbing Alcohol Sinus Medications Sleeping Aids used to treat occasional insomnia Special Ointment or Cream for Sunburn Spermicidal Foam Thermometers (ear or mouth) Throat Lozenges Visine and other such eye products Wart remover treatments
Top

	Examples of Dual Purpose – must be accompanied be a licensed medical practitioner’s note stating specific medical condition:

	Acne treatment (Retin A) – only to treat a specific medical condition such as acne vulgaris Dietary Supplements or Herbal Medicines to treat a specific medical condition in narrow circumstances Fiber Supplements under narrow circumstances Glucosamine/Chondroitin for arthritis or other medical condition Orthopedic Shoes and Inserts (for orthopedic shoes, you can only be reimbursed for the extra cost over buying non-orthopedic shoes) OTC Hormone Therapy and treatment for menopause to treat symptoms such as hot flashes, night sweats, etc. Pills for persons who are Lactose Intolerant Prenatal Vitamins St John’s Wort for Depression Sunscreen Weight-Loss Drugs to treat a specific disease (including obesity)
Top
	Also, the expense for coverage under any of the following constitutes an HSA qualified medical expense:

	COBRA coverage; A qualified long-term care insurance contract; Any health plan maintained while the individual is receiving unemployment compensation under federal or state law; or, For those age 65 or over (whether or not they are entitled to Medicare), any deductible health insurance (e.g., retiree medial coverage) other than a Medicare supplemental policy.