Microsoft word - fsa hra nfcsd ineligible medical expenses

Expenses that ARE NOT Covered Under
Niagara Falls City School District’s
Health Flexible Spending or Health Reimbursement Account

Over-the-counter products
*physician’s prescription required to be eligible for the majority of over-the-counter products
Prescription is good for one year from the date it was written, and will need to be resubmitted
annually.
Medical Expenses
Administrative Costs

Ear piercing
Allergy treatment products
Face lifts
allergies, such as a pillow or a vacuum. Automobile insurance premiums
Finance charges/interest charges
Baby sitting and child care
Fitness programs/health club
memberships (without a prescription)
children even if the expenses enable you to Founder’s fee
get medical or dental treatment. Also, any Funeral expenses/burial expenses
cannot be treated as an expense paid for Home or automobile equipment
Bottled water
Household and domestic help
Child rearing classes
dependent’s inability to perform physical COBRA premiums
Contact lens replacement insurance
Illegal operations and treatments
Cosmetic surgery
Life insurance or other insurance
Unless amounts paid for surgery necessary premiums
congenital abnormality, personal injury from Lifetime care – advance payments
disease. “Cosmetic surgery” means any Lodging while attending a medical
procedure which is directed at improving the conference
meaningfully promote the proper function of Long-term care services or insurance
premiums
Marijuana or other controlled substances
Dancing lessons
Marriage counseling
Diapers or diaper service
Domestic help fees of a non-medical
Massage therapy
Unless prescribed by a doctor to treat a specific injury or trauma. Doctor’s note of Psychoanalysis
psychoanalysis that you must get as a part Maternity clothes/uniform
Medical savings accounts
No, if purchased over-the-counter or for Medicare Part A and/or B
cosmetic purposes, even if prescribed by a Missed appointment fees
Nursing services for a baby
Scientology “audits”
Personal use items
Solutions for the care and maintenance
of eyeglasses
Physical therapy treatments for general
well-being
Stress-related services
Pre-payment for services
Student health fee
No, reoccurring student health fees are not Private hospital rooms
reimbursable as they are not incurred for The extra amount paid for the private room any specific treatment. The IRS views these Problem child
Swimming lessons
special school for benefits that the child may Supplements prescribed by an
alternative provider (e.g., naturopath or
homeopath)
Teeth whitening/bleaching
Toothbrush – battery-powered or electric
Weight loss treatments not by
prescription

If you have questions regarding a medical service or expense that is not listed on this
form, please contact the M&T Insurance Agency Flexible Spending Department:
Toll-free

Source: http://www.nfschools.net/cms/lib/NY19000301/Centricity/Domain/95/FSA%20HRA%20NFCSD%20Ineligible%20Medical%20Expenses.pdf

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