Using Your Benesyst Benny™! Over-The-Counter (OTC) Drugs FSA Guide
Over-The-Counter Drugs & Products Reimbursable through a Healthcare Flexible Spending Account
IRS Revenue Ruling 2003-102, permits many OTC drugs to be reimbursed medical expenses in an FSA. Under the ruling, (OTC) drugs purchased without a physician’s prescription are reimbursable as long as the item alleviates illness or injury. Outlined below are examples of Medical-only and Dual-purpose OTC drugs that are reimbursable as well as OTC drugs that are excluded. Medical-only list These OTC drugs are deemed to have a solely (or primarily) medical purpose. For FSA Reimbursement, the (itemized) actual name of the product must appear on the merchant receipt AND itemized on the Benesyst claim form. If the receipt does not
include the name please copy the label from the product and circle the correct amount on your receipt. Handwritten names are not acceptable.
• Analgesics – migraine preparations, acetaminophen, anti-inflammatory including non-steroidal,
salicylates (aspirin), i.e. cold and flu medicines, sinus and allergy relief, pain relievers Examples: Ibuprofen, Tylenol, Excedrin, Sudafed, TheraFlu, Robitussin, Sinutab, Actifed, Tavist D, Vicks 44M,
• Antihistamines – Examples: Benadryl, Claritin, Contac, Dimetapp, Pediacare • Gastrointestinal Agents – antacids, calcium antacids/combinations, magnesium antacids, antacid
preparations, antiflatulent combinations Examples: Gas-X, Maalox, Mylanta, Tums, Alka-Seltzer, Gaviscon, Pepcid AC, Rolaids, Ex-lax, Milk of Magnesia, Prilosec, Zantac, Immodium caplets, Phazyme
• Antidiarrheals – Examples: Imodium A-D, Kaopectate, Pepto-Bismol • Antiemetics – for motion sickness Examples: Bonine, Dramamine, Emetrol • Antifungal & Combinations – Examples: Desenex, Lamisil, Lotrimin, Nizoral, Monistat • Anorectal Preparations – Examples: Anusol, Cortizone, Hurricaine topical, Preparation H, Tucks • Antiseptic & Combinations – Examples: Anbesol, Bactine, Hurricaine topical, Betadine, Neosporin,
• Anti-itch medications – Examples: Anusol, Benadryl, Caladryl, Cortizone, Vagisil • Birth Control Devices • Burn Preparations – Examples: see Antiseptic & Combination examples • Canker Sore/Cold Sore Preparations – Examples: Anbesol, Abreva, Gly-Oxide, Carmex, Blistex • Cold & Cough Preparations, Cough Drops, Expectorants • Constipation Aids • Contact Lenses & Contact Lens solution • Decongestants & Nasal Strips • Diaper Rash Relief • Ear drops (for pain), ear wax removal • Fever Preparations • First Aid (see Wound Care) • Head Lice Relief • Hemorrhoid Creams & Suppositories • Incontinence Supplies • Lactose intolerance – Examples: Lactaid Fast Act, Lactaid, Dietary Relief • Laxatives (non-fiber and fiber) – Examples: Benefiber, Konsyl, Metamucil Fibersure • Masks (ear loop) and/or latex gloves – Examples: Ansell, Safeskin, Flents, Nexcare • Menstrual Cycle Products For Pain And Cramp Relief • Monitoring Devices – Examples: glucose tester • Muscle/Joint Pain Creams/Wraps – Examples: BenGay, Cold /Hot packs, ThermaCare Heat Wraps • Nasal Sinus Sprays Benesyst, 800 Washington Ave N, 8th Floor, Minneapolis, MN 55401-1173 Customer Care Center: (800) 670-7131, www.benesyst.net [email protected] Over-The-Counter (OTC) Drugs FSA Guide
Over-The-Counter Drugs & Products Reimbursable through a Healthcare Flexible Spending Account
• Nausea Medications • Nicotine Gum Or Patches • Orthopedic shoes and inserts (for orthopedic shoes, reimbursed the excess cost over non-
• Pedialyte For Child’s Dehydration • Prenatal vitamins – during pregnancy only • Psoriasis and Eczema Medications – Examples: Dermarest Medicated, Psoriasin, SkinZinc • Sleep Aids – Examples: Tylenol PM, Legatrin PM, Excedrin PM • Sunburn Cream • Thermometers (Ear/Mouth/Rectal/Infant) • Throat Lozenges & Sprays – Examples: Halls, Vicks, Sucrets • Visine And Other Eye Products including all contact lens solutions • Wart Remover Products • Wrist Support for Carpal Tunnel • Wound Care – Examples: Bandages, First Aid Creams, Gauze Pads, First Aid Kits, Rubbing Alco-
hol, Peroxide, Liquid Adhesive for small cuts
Dual-purpose list (Doctor’s Note Required) The following items are deemed by the IRS to be “Dual Purpose”; they have a medical purpose, which would make the item reimbursable, and a personal/ cosmetic/general health purpose which would make them NON-reimbursable. If you wish to have FSA reimbursement on any item below, you must include a medical doctor’s note specifying the medical diagnosis, medical condition, necessity, treatment, and duration.
• Acne preparations (Proactiv, AcneFree, etc.)
• OTC hormone therapy and treatment for menopause to treat symptoms such as hot flashes, night sweats, etc.
• Weight-loss drugs to treat a specific disease including obesity
Excluded items (OTC drugs that are NOT reimbursable, per the IRS)
• Sunscreen (not sun tanning lotion) excluded unless presented with a doctor’s note (2009 change due to IRS ruling)
• Toiletries, tissue, cosmetics or items (including RX) primarily used for general health & every day living
• Toothpaste or toothbrushes (electric or otherwise), even if a dentist recommends, • Dental whitening/bleaching systems, floss
• Chapstick for chapped lips, lip balms, gloss, etc.
• Mouth washes, oral rinses (that claim to treat bad breath, gingivitis)
• Face/body creams/moisturizers (with a SPF), cleansers, oils, gels, lotions – for all skin types (i.e. itchy dry skin) and suntan lotion
• Scar care: creams, ointment, sheets, solutions • Shampoos and soaps including medicated
• Supplements (herbal or combination) for general health, weight loss, protection of disease and normal function of the body
• Feminine products as well as hygiene products, lubricants, cleansers, wipes, sprays, etc.
• Immune system support • Personal use items i.e. bed coverings/accessories, vacuums, furniture
Information is from the Physicians’ Desk Reference for Over-the-Counter Drugs. This list is not all inclusive; it may change at any time. Purchases are for consumption or use in the Plan Year; stock-piling of one or several items are not permitted and will be denied; especially at the end of a Plan Year.
Benesyst, 800 Washington Ave N, 8th Floor, Minneapolis, MN 55401-1173 Customer Care Center: (800) 670-7131, www.benesyst.net [email protected]
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YOUR BENEFITS Benefit Summary Outpatient Prescription Drug 10/35/60 Plan 02V Your Copayment and/or Coinsurance is determined by the tier to which the Prescription Drug List Management Committee has assigned the Prescription Drug Product. All Prescription Drug Products on the Prescription Drug List are assigned to Tier 1, Tier 2 or Tier 3. Find individualized information on your ben