Flexible Spending Account/Dependent Care Expenses

The Health Care FSA can cover a wide variety of expenses. We’ve assembled a list of common expenses that are eligible for reimbursement as well as common expenses that are ineligible. Some services may be eligible if you meet certain criteria.

For details on the September 2003, IRS ruling that allows over the counter drugs and medicines to be reimbursed by a Health Care FSA, click here.

To view a list of eligible expenses not relating to over the counter drugs and medicines, click here.

Eligible over the counter expenses include the following:

Ace bandages Contacts Lactose intolerance pills Pepto-Bismal
Actifed Contact lens solution Lamisil Pregnancy tests
Allergy medication Cortaid Lotrimin Prenatal vitamins
Advil Cough medicine Laxatives Preparation H
Aleve Crutches Little Colds Prescription medicines
Alka Seltzer Dayquil Little Noses Primatine Mist
Antacids Desitin Maalox Prilosec
Anacin Dimetapp Marazine Reading glasses
Anti-diarrhea medicine Diaper rash ointments Micatin Riopan Plus
Bactine Dulcolax Midol Robitussin
Balmax Dramamine Mentholatum Rolaids
Bayer Drixoral Milk-o-Magnesia Rubbing alcohol
Bandage tape Excedrin Monistat Saline solution
Band-Aids Ex-Lax Mylanta Simply Cough
Ben Gay Eye drops Motion sickness Sinus medication
Benadryl First Aid creams Medication Sudafed
Bufferin First Aid kits Motrin Syrup of Ipecac
Burn creams First Aid supplies Neosporin Tagamet
Calamine Flexall Nicoderm Thera-Flu
Caladryl Gauze Nicorette Thermometers
Chiropractic Gaviscon Nicotrol Tiger Balm
Chlor-Trimitron Gas-X Nicotine gum/patch Tinactin
Chloraseptic Gyne-Lotrimin Nyquil Triaminic
Claritin Hearing aids Orajel Tums
Cold medicine Hemorrhoid medication Pamprin Tylenol
Compound W Hydrocortisone Pain relievers Vagisil
Condoms Incontinence supplies PediaCare Visone
Contac Immodium AD Pepcid AC Vicks
Contraceptive foams Kaopectate    

Ineligible health care expenses include the following:

These services are not eligible through a Health Care FSA under any circumstances.

Breast Pumps Health Club Dues Marriage Counseling Sonicare Products
Cosmetic Surgery Herbs Marijuana Supplements
Dental Bleaching Humidifiers Medicated shampoo/soap Toiletries
Dental Hygiene Products Hypoallergenic Linens Neck support Pillows Vitamins
Electrolysis Hypoallergenic Pillows Sex Change Weight Loss Meals
Family counseling Insurance Premiums Skin Moisturizers  

Documentation Required

There is a small group of items that may be allowed if and only if you are diagnosed by a medical doctor (M.D.) with a specific medical condition and that the specific item is medically necessary to treat the condition. These items must be to treat the condition and cannot be for preventative purposes.

Acne Treatment Chondroitin Glucosamine St. John’s Wort
Blood Pressure Machine Custom Orthodics Hormone Therapy Sunscreen
Cayenne Pepper Fiber Supplements Massage Therapy Vitamins

For example:

An individual suffers from anemia and the doctor prescribes iron supplements to treat the anemia. The medical doctor would need to diagnose the participant with anemia and provide a letter stating the diagnosis and that iron supplements are medically necessary to treat the condition. The participant would need to be diagnosed with the condition in order for the expense to be eligible. The iron could not be allowable for someone who may be at risk for anemia and is taking it for preventative reasons.

Remember, it will be your responsibility to find out if a service is eligible before you sign up for the benefit.


To submit a Claim, you may either fax in copies of your bill to 405.858.1125 or 405.843.1953. Or you may scan and email in your completed claim forms with all necessary receipts to flex@maa-tpa.com. You may also mail claim forms and receipts to:

Mutual Assurance Administrators
Attn: Flex/Dependent care department
3121 Quail Springs Pkwy
OKC OK 73134

Lighthouse 1 Flex On Line Access

Flexible Spending Withdrawal Request
Use this form to request reimbursement from your FSA account to cover expenses incurred by you or any family member covered by your Plan.

A Simple Reminder!!!

Please include copies of EOB’s from your health plan to document unreimbursed medical expenses (such as deductible, coinsurance and copay amounts). Balance due statements, credit card receipts or statements or canceled checks are not accepted.

A Complex Reminder!!!

IRS requires health Flexible Spending Account claims be substantiated with two items:

  1. A written statement from the independent third party providing that the medical expense has been incurred and the amount of the expense; and
  2. A written statement from the participant providing that the medical expense has not been reimbursed and that the participant will not seek reimbursement from any other health plan coverage.