Eligible expenses

Eligible Expenses for your PEBB Medical FSA The Medical Flexible Spending Arrangement (FSA) covers health care expenses for you, your spouse, or your qualified dependents. Below is a list of common expenses that may be eligible for reimbursement, eligible expenses that may require extra documentation, and ineligible expenses. Not all eligible or ineligible items are on this list. For a full list, visit pebb.naviabenefits.com/benefits/expenses or call Navia Benefit Solutions at (800) 669-3539. You are responsible for providing sufficient, accurate information when submitting claims for reimbursement. To ensure compliance with IRS requirements, Navia Benefit Solutions reserves the right to require additional documentation for any claim submitted. Eligible Health Care Expenses Acupuncture Cold sore treatment Insect bite treatment Prescription glasses Allergy & sinus medication Cold/cough medication Lab work Reading glasses Antacids Contacts & solutions Lactation consultant Respiratory treatments Antibiotic ointment Contraceptives Lactose intolerance pills Saline nasal spray Anti-diarrheal Copays Laser eye surgery Sleep aids & sedatives Antifungal foot cream CPAP machine Laxative Sleep deprivation treatment Anti-gas medication Crutches Lice treatment products Smoking cessation programs Anti-itch cream/gel Deductibles Medical records & products Antiseptic Dental services Menstrual care products Speech therapy Asthma treatment Diabetic supplies Motion sickness relief Sterilization procedures Bandages/gauze Diaper rash ointment Naturopathic visits Stool softener Birthing classes or Lamaze Digestive aids Orthodontia Sunscreen SPF 15 or more Blood pressure monitor Drug addiction treatment Oxygen & equipment Thermometer Braces (knee, ankle, wrist) Feminine anti-fungal/anti-itch Pain relievers Throat lozenges Braille books Fertility monitor Parasitic treatment Vaccinations Breast pump Fertility treatment Physical exams Vision care Burn cream Flu shots Physical therapy Walker Chiropractic services Hearing aids & supplies Pregnancy test Wart treatment Coinsurance Hemorrhoid medication Prenatal vitamins Wheelchair & repair Cold/hot pack Home medical equipment Prescription drugs Individual counseling 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 will need a Letter of Medical Necessity (LMN) for the expenses below before they can be reimbursed. Not all items requiring an LMN are on this list. For a full list and to download a printable copy of the LMN, visit pebb.naviabenefits.com or call Navia Benefit Solutions at (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 Common Ineligible 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. For a complete list, visit pebb.naviabenefits.com or call Navia Benefit Solutions at (800) 669-3539. Activity tracker Electrolysis/laser hair removal Hygiene products Marriage counseling Airborne Face lift Illegal operations/substances Massage chair Books Finance charges Imported OTC items Mattress Boutique practice fees Funeral expenses Imported prescriptions Missed appointment fee COBRA premiums Gym membership Insurance premiums Teeth whitening College insurance Hair growth products Late fees Toiletries CPR classes Hair transplant Liposuction Warranties Electric toothbrush/picks Household help Marijuana