Annual Prescription Costs:
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$
Almost all prescription drugs are eligible for reimbursement.
Please note that starting in 2011, you are required to obtain a prescription in order to be reimbursed for OTC drugs and medications such as pain relievers and cold medications.
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Annual deductible expense:
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$
Deductible expenses for your major medical plan are eligible for a tax break.
Please note that expenses for your spouse's deductible are also eligible for your FSA, even if he/she has a different insurance plan.
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Co-payment expenses for doctor visits:
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$ Office visit and specialist co-payments are eligible for a tax break!
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Dental Expenses:
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$ Dental procedures such as root canals, crowns, routine cleaning and orthodontia are eligible through your FSA. Please note there are special rules that apply to orthodontia, so please contact ASIFlex with questions.
Teeth bleaching expenses are not eligible.
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Vision Expenses (glasses, contact lenses, etc.):
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$ Glasses, prescription sunglasses, contact lenses, and laser eye surgery are eligible expenses.
Protection plans and warranties are not eligible for reimbursement.
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Chiropractic care:
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$
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Acupuncture costs:
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$ Costs for visits with a provider are eligible for reimbursement.
PLEASE NOTE: herbal supplements/remedies will require a letter of medical necessity (which can be written by your acupunturist).
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OTC supplies (band-aids, contact lens solution, etc.)
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$
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Other Eligible Expenses:
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$
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| Total Anticipated Annual Medical Expenses |
$ |