Do all prescription medicines qualify for reimbursement? Generally, yes, as long as they are prescribed by a physician and are legal under federal and state laws. However, prescriptions that are purchased solely for cosmetic purposes and that don’t treat an existing medical condition do not qualify. When is additional documentation required? Certain expenses are not reimbursable under a Medical FSA unless a licensed health care practitioner states in writing to Navia Benefit Solutions that the service or product is medically necessary. Navia Benefit Solutions will need a Letter of Medical Necessity (LMN) for the items below before they can be reimbursed. Not all items requiring an LMN are on this list. For a complete list, and to download a printable copy of the LMN, go to pebb.naviabenefits.com or call Navia Benefit Solutions at 1-800-669- 3539. Acne treatment Breast reduction Lodging and meals Vitamins & supplements Automobile modifications Cosmetic procedures Special foods Weight loss programs Breast augmentation In vitro fertilization Veneers Orthodontia expenses Unlike other Medical FSA expenses, which are deemed incurred when the services occur, orthodontia expenses are considered incurred when paid. Therefore, only payments made during your eligibility period or plan year (whichever ends first) may be reimbursed. Proof of payment to an orthodontia provider or a completed Orthodontia Contract is required for reimbursement. You can download a printable copy of the Orthodontia Contract by visiting pebb.naviabenefits.com or calling Navia Benefit Solutions at 1-800-669-3539. Stockpiling IRS regulations prohibit you from receiving a reimbursement from your Medical FSA for a large quantity of any item in any one transaction. Buying more than three of the same item in any one transaction is considered stockpiling and will not be reimbursed. Ineligible health care expenses The following expenses are not eligible under a Medical FSA. Under no circumstances will the following items be reimbursed. Do not submit claims for these items; they will be denied. For a complete list, visit pebb.naviabenefits.com or call Navia Benefits Solutions at 1-800-669-3539. Activity tracker Funeral expenses Liposuction Airborne Gym membership Marijuana Books Hair growth products Marriage counseling Boutique practice fees Hair transplant Massage chair COBRA premiums Household help Mattress College insurance Hygiene products Missed appointment fee CPR classes Illegal operations/substances Teeth whitening Electric toothbrush/picks Imported OTC items Toiletries Electrolysis/laser hair removal Imported prescriptions Warranties Face lift Insurance premiums Finance charges Late fees An expense is also not eligible for reimbursement under a Medical FSA if the expense has already been reimbursed under this plan or by any other source. When submitting an expense, you will also be required to certify that you will not seek or be reimbursed for the expense by any other source or insurance. How do I get reimbursed? Navia Benefit Solutions will send you a claim form when you enroll in the Medical FSA. Submit your claim and documentation to Navia Benefit Solutions for reimbursement. The documentation must show the: • Provider’s name • Name of the person receiving the service or expense 6