Effective January 1, 2011, Medical FSA (Health Care Spending Account) funds may no longer be used for OTC drugs and medicines (other than insulin) without a directive from a medical provider. This means that beginning January 1, 2011, if an OTC drug or medication is required to treat a specific medical condition, you may submit a claim for reimbursement, but you must include a Certification of Medical Necessity form completed by your medical provider OR a statement of necessity on the medical provider’s letterhead, signed and including the required information.
This rule does NOT apply to eligible OTC MEDICAL SUPPLIES that are not drugs or medicines (e.g. bandages, orthopedic braces). These items can still be submitted by means of an itemized receipt.
Along with your completed claim form, as of 1/1/2011, you will be required to submit an itemized receipt (provider/date of purchase/name of item/cost) and the completed Certification of Medical Necessity or statement of medical necessity on provider letterhead.
To be eligible for reimbursement, a medical item must be used “primarily for the prevention or alleviation of a physical or mental defect or illness” and would not be used except for a particular medical condition. A drug or medication requires a Certification of Medical Necessity completed by your medical provider. The item must be used by the Medical FSA participant or the participant’s spouse or dependent. The item must NOT be used for general health (e.g. toothpaste, mouthwash, lotion, shampoo) or cosmetic purposes (e.g. tooth whitening products, wrinkle removers).
The expense must be for medical care during the timeframe of your FSA plan year. Reasonable quantities of eligible OTC items are reimbursable if purchased for either existing or imminent medical conditions. If large quantities are necessary, the medical provider must indicate that the quantity being purchased is necessary for the treatment.
For your convenience, please see the following:
| Certification of Medical Necessity form (downloadable and printer-friendly) |
| Sample OTC Item Eligibility Chart showing samples, both of those items requiring Certification of Medical Necessity, and of those items not requiring it |