Medical Reimbursement Account (MRA) Eligible Expenses

Introduction

This guide includes a list of health care expenses and lets you know whether you can use the money in your Medical
Reimbursement Account (MRA) to pay for the health care expense. Eligible health care expenses are health care costs
that result from the diagnosis, care, treatment, improvement, or prevention of a disease or illness.

About Your MRA

Who can I spend my MRA funds on?

You can use your MRA to pay for eligible health care services received or health care items purchased by you,
your spouse or domestic partner, and your children or dependents.

Who qualifies as my dependent?

A dependent is a child or relative who lives with you for more than half the year and receives more than
half of his/her financial support from you. Dependents may include full-time students ages 19 through 26 and
children over age 19 who are permanently disabled. A relative must receive more than half of his/her financial
support from you and not be your child or the child of any other taxpayer to qualify as a dependent.

How to Use the Guide

Unless we specifically mention it in this guide, the rules related to the health care expense apply to both the SF MRA and SF Covered MRA programs.

Find the health care expense.
See if the expense is eligible for reimbursement.
- Each expense is in one of three categories:
- Eligible – This expense is eligible for reimbursement from your MRA.
- Potentially Eligible – This expense may be eligible for reimbursement based on meeting certain requirements.
- Ineligible – This expense is not eligible for reimbursement from your MRA.
If the expense is potentially eligible for reimbursement, find out what additional requirements apply or additional documentation you need to provide.
For expenses where “Provider’s Statement Required,” the documentation needs to include: provider’s name,patient’s name, description of the medical condition, description of the treatment needed, length of time the treatment will be needed, and explanation of how the treatment will help the medical condition.

HEALTH CARE EXPENSE TYPE	ELIGIBLE FOR REIMBURSEMENT	SPECIAL REQUIREMENTS
A
AA, Alcoholism, Drug, or Substance Abuse Treatments • Alcohol or substance abuse treatment center, including meals and lodging	Yes
Abortion	Yes
Acne Treatment • Acne medication • Acne peels • Cryosurgery • Dermabrasion • Laser Treatment	Yes
Activity Tracker	Potentially Eligible	Provider’s statement required
Acupuncture • Acupuncture • Acupressure	Yes
Adoption Fees	No	You may submit health care expenses for an adopted child once they become your qualified dependent, including health care expenses incurred during the adoption process, such as physical examinations.
Affordable Care Act (ACA) Penalties	No	Tax penalties for not complying with the individual mandate of the Affordable Care Act (also known as the ACA or “Obamacare”) are not eligible for reimbursement.
Air Conditioner or Purifier (for allergy or asthma relief)	Potentially Eligible	Provider’s statement required.
Allergy Relief (Equipment and Supplies) • Air purifier • Humidifier • Nebulizer • Vaporizer • Air filters • Special vacuum cleaners • Special pillows, mattress covers, etc. to alleviate an allergic condition • Removal of flooring	Potentially Eligible	Provider’s statement required.
Allergy Relief (Medicine and Shots) • Allergy shots • Nasal irrigation supplies (e.g. Neti Pot) • Over-the-counter allergy medication • Prescription allergy medication • Saline eye drops • Saline nasal aspirators or sprays	Yes
Ambulance Services	Yes
Anti-Itch Lotions and Creams	Yes
Artificial Insemination • Fertility exams • Embryo replacement and storage • Egg donor: recipient’s medical expenses • In-vitro fertilization • Sperm bank/semen storage for artificial insemination • Sperm implants due to sterility • Sperm washing • Surrogate pregnancy: donor’s medical expenses, surrogate’s medical expenses	Yes	See also Fertility Treatments
Artificial Limb (prosthesis) or Teeth (dentures or implants)	Yes
Asthma Medicines	Yes
Audio Books • Books on tape • Books on CD • Books online or other digital formats	Potentially Eligible	Documentation of a visual impairment or other disability that necessitates an audio/electronic version is required.
Automobile • Installing equipment such as hand controls, lifts, or ramps • Special-design vehicles	Potentially Eligible	Provider’s statement required.
B
Baby Formula	Yes
Birth Control / Family Planning • Birth control pills, patches, or rings • Condoms • Diaphragm or IUD • Norplant or Depo-Provera • Ovulation kits • Spermicides • Tubal ligation • Vasectomy	Yes
Blood Storage	Yes
Body Scan • CT body scanning • Full body scanning	Yes
Botox Treatment	Potentially Eligible	Provider’s statement required. Botox used to improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma is an eligible expense. Botox used for the treatment of migraines is an eligible expense.
Braces and Other Orthodontics	Yes
Braille Books and Magazines	Yes
Breast Pumps and Related Supplies	Yes
C
Capital Modification (House) A capital modification is an expense incurred for the primary purpose of accommodating a personal residence to a disability. • Constructing ramps • Widening doorways • Installing railing or support bars to bathrooms, stairways, etc. • Lowering or modifying kitchen or bathroom cabinets • Altering the location of, or modifying electrical outlets and fixtures • Installing porch lifts and other forms of lifts • Modifying fire alarms, smoke detectors, and other warning systems • Modifying hardware on doors • Grading of ground to provide access to the residence • Isolation of lead-based paint through wall covering (wallboard, paneling) • Removal of lead-based paint This list is not exhaustive.	Potentially Eligible	Only reasonable costs incurred to accommodate a personal residence to the disability are eligible. Additional costs for personal reasons, such as architectural or aesthetic reasons, are not allowable as medical expenses.
Childbirth-Related • Childbirth prep classes (Lamaze) • Midwife fees • Maternity girdles (for back pain) or special support hose (for leg circulation) • Home pregnancy tests • Ovulation kits • Doula fees • Lactation consultants	Yes
Chiropractor Fees	Yes
Christian Science Practitioners	Yes
Church of Scientology Practitioners	No
Circumcision	Potentially Eligible	Fees for “ritual” circumcision performed by a non-health care provider (e.g., rabbi, mohel) are not eligible.
Classes, Health-Related	Potentially Eligible	Provider’s statement required. The purpose of the training must be for the treatment of a medical condition and not for the promotion of general health
Coinsurance • The portion of a medical bill exceeding the deductible that is shared with the health insurer.	Yes
Cold and Flu Medicine (e.g. Dayquil, Nyquil, Sudafed, Theraflu, Triaminic, Tylenol Cold and Flu)	Yes
Cold Sore/Fever Blister Treatment	Yes
Colonic Cleansing/Wash	No
Concierge (Boutique) Fees	Yes	Membership or retainer fees to a provider for eligible health care services.
Condoms	Yes
Contact Lenses and Contact Lens Cleaner	Yes
Contraceptive Products	Yes	See Birth Control / Family Planning.
Copayments	Yes	See Insurance Co-Pays.
Cord Storage	Yes
Cosmetic Products • Face soaps • Creams • Makeup • Perfumes • Hair removal	No
Cosmetic Surgery and Procedures • Dental veneers, bonding, tooth whitening/bleaching • Facelifts • Blepharoplasty • Sclerotherapy • Botox or Collagen injections This list is not exhaustive.	Potentially Eligible	Provider’s statement required. A cosmetic surgery or procedure can be an eligible expense if it is necessary to improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma.
Counseling • Psychotherapy and psychoanalysis • Sex therapy • Bereavement and grief counseling • Telephone counseling • Marriage counseling	Yes
Cough Relief, Cough Medicine, and Cough Drops	Yes
Crutches	Yes
D
Dancing or Swimming Lessons, etc.	No
Decongestants (e.g. Claritin-D, Neo-Synephrine, Sudafed)	Yes
Deductibles	Yes	See Insurance Deductibles
Dehydration/Rehydration (e.g. Pedialyte)	Yes
Dental Care and Prevention • Cleaning • X-rays • Fillings • Braces or other orthodontics • Extractions • Dentures • Bonding and sealants for dentures • Sealants (non-denture) • Crowns • Porcelain veneers (if not cosmetic) This list is not exhaustive.	Yes
Dental Products • Dental Floss • Toothpaste • Toothbrushes • Teeth whitening kits	No
Dental Treatment – Cosmetic • Teeth whitening or bleaching • Porcelain veneers This list is not exhaustive	Potentially Eligible	Provider’s statement required. A cosmetic surgery or procedure can be an eligible expense if it is necessary to improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma.
Dentist Fees • General/Family Dentist • Oral Surgeon • Orthodontist • Endodontist • Periodontist This list is not exhaustive.	Yes
Diabetic Supplies • Sterile cotton balls • Alcohol prep swabs • Glucose tablets • Glucometer and test strips • Insulin • Needles (lancets) • Syringes • Glucagon emergency kit • Ketone urine test strips • Training classes	Yes
Diapers or Diaper Service	Potentially Eligible	Diapers for disabled individual, other than a newborn, are eligible, but only if needed to relieve the effects of a particular disease.
Doctor Fees • Anesthesiologist • Chiropodists • Chiropractor • Christian Science Practitioner • Dermatologist • Gynecologist • Naturopath • Neurologist • Obstetrician • Oculist • Oncologist • Ophthalmologist • Optician • Optometrist • Orthopedist • Osteopath • Otorhinolaryngologist • Pediatrician • Physician • Podiatrist • Psychiatrist • Physiotherapist • A physical without diagnosis or not covered by insurance • Consultations • Transfer of medical records • Any expense a doctor may charge to write a provider’s statement This list is not exhaustive.	Yes	Fees include the portion of the expense not paid for by other health insurance (the “out‑of‑pocket” portion). Late fees, finance fees, fees for missed appointments, etc., are not eligible medical expenses.
Drugs/Medicines – Prescriptions	Potentially Eligible	Expenses must involve prescription drugs/ medicines that could be legally provided within the U.S.
Drugs/Medicines – Over-the-Counter • Anti-Itch Lotions and Creams • Asthma Medicines • Cold Sore/Fever Blister Treatment • Cold and Flu Remedies • Contraceptive Products • Cough Medicine and Relief • Decongestants • Dehydration/Rehydration • Diaper Rash • Eye Drops • Hemorrhoidal Preparations • Migraine Relief • Motion Sickness • Sinus Products • Smoking Cessation • Sunburn Relief • Sunscreen • Teething/Toothache Relief • Topical Steroids • Wart Removal This list is not exhaustive.	Yes
Drug Addiction Treatment	Yes
E
Electrolysis or Hair Removal	Potentially Eligible	Provider’s statement required. Electrolysis or hair removal can be an eligible expense but only if it is necessary to improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma.
Exercise Equipment and Programs • Exercise videos • Exercise DVDs	Potentially Eligible	Provider’s statement required. The exercise equipment and program must treat a medical condition diagnosed by a health care provider (e.g., obesity, diabetes, high blood pressure). The cost of a weight loss program to improve your general health and appearance is not an eligible
Eye Drops	Yes
Eyeglasses and Eye Care • Eye examinations • Contact lens, fitting fee, replacement lens • Contact lens solutions • Reading glasses • Prescription glasses, prescription sports goggles, prescription sunglasses, scuba masks or safety glasses • Artificial eye and polish • LASIK/laser surgery, radial keratotomy, or other vision correction surgery • Vision insurance premiums	Yes	The following items are not eligible: • Eyeglass or other vision-related warranties • Non-prescription sunglasses • Non-prescription cosmetic contact lenses • Clip-on sunglasses
F
Face Masks (for respiratory protection)	Yes
Facility Fees • Hospital • Nursing home • Rehabilitation facility • Home for mentally or physically disabled	Yes
Feminine Hygiene • Maxi pads • Menstrual cups • Tampons	Yes
Fertility Treatments • Artificial insemination • Fertility exams • Embryo replacement and storage • Egg donor: donor’s medical expenses, recipient’s medical expenses • In-vitro fertilization • Sperm bank/semen storage for artificial insemination • Sperm implants due to sterility • Sperm washing • Surrogate pregnancy: donor’s medical expenses, surrogate’s medical expenses • Reverse vasectomy • Reverse tubal ligation	Yes
Fiber Supplements	Yes
First Aid Supplies/Wound Care (e.g. Band-Aids, Neosporin)	Yes
Fitness Tracking Device	Potentially Eligible	Provider’s statement required.
Fluoride Treatments (e.g., fluoride rinses)	Yes
Food Supplements (e.g. Ensure, Pediasure)	Yes
Funeral Expenses	No
G
Gender Re-Assignment • Surgery • Counseling • Hormone therapy	Yes
Genetic Testing	Potentially Eligible	Provider’s statement required.
Guide Dogs • Cost of the animal • Care of the animal	Potentially Eligible	Provider’s statement required.
Gym Fees • Gym Membership Fees • Gym Class/Trainer Fees	Potentially Eligible	Provider’s statement required. Amounts paid for gym fees for your general health not related to a particular medical condition are not eligible expenses.
H
Hair Loss Treatment	Potentially Eligible	Provider’s statement required. Hair loss treatment can be an eligible expense if it is necessary to improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma. Treatment for hair loss that occurs as a normal part of aging or inherited or genetic baldness, or for cosmetic purposes, would not be covered. See also Wigs or Toupees.
Hair Transplant	Potentially Eligible	Provider’s statement required. Surgical hair transplants can be an eligible expense if it is necessary to improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma. Treatment for hair loss that occurs as a normal part of aging or inherited or genetic baldness, or for cosmetic purposes, would not be covered. See also Wigs or Toupees.
Health Club Dues	Potentially Eligible	Provider’s statement required. Amounts paid for health club dues or steam baths for your general health or to relieve physical or mental discomfort not related to a particular medical condition are not eligible expenses.
Health Expenses Incurred Outside of the United States	Potentially Eligible	Provider’s statement required. Expenses must involve medical care or drugs/ medicines that could be legally provided within the U.S.Provider’s statement required. Expenses must involve medical care or drugs/ medicines that could be legally provided within the U.S.
Health Insurance Premiums	Yes	See Insurance Premiums.
Health Screenings or Routine Medical Exams (e.g. VDRL, cholesterol, diabetes glucose, blood pressure)	Yes
Healthy San Francisco Participant Fees	Potentially Eligible	Eligible for reimbursement through SF MRA. Not eligible from reimbursement through SFCovered MRA.
Hearing Aids • Purchase price and maintenance cost for hearing aid • Batteries needed to operate the hearing aid • Television or telephone adapter for the deaf • Lip reading lessons • Hearing exams	Yes	The cost of the television or telephone would not be eligible. An eligible expense would only include special modifications needed for a disabled person to use the television or telephone.
Hearing Exams	Yes
Heart Monitors	Potentially Eligible	Provider’s statement required. Monitors tracking heart rate during exercise for general purposes not eligible.
Hemorrhoidal Preparations	Yes
Hippotherapy Therapeutic horseback riding	Potentially Eligible	Provider’s statement required. Recreational horseback riding is not an eligible expense.
Home for Mentally Disabled Persons	Yes	The cost of keeping a mentally disabled person in a special home, not the home of a relative, on the recommendation of a psychiatrist to help the person adjust from life in a mental hospital to community living.
Hospital Services/Fees • Private room fees • Hospital kits (water pitcher, razor, toothbrush, lotion, etc.)	Yes
House Modification	Potentially Eligible	See Capital Modification.
Household Help • Cleaning services • Cook/chef • Personal assistant • Driver • Gardener	No	Certain expenses paid to an attendant providing nursing type service may be eligible. See Nursing Services.
Human Chorionic Gonadotropin (HCG) Injections	Potentially Eligible	Provider’s statement required. HCG injections may be eligible for infertility treatment or to test for tumors, but not for general weight loss or steroid enhancement unrelated to a medical condition.
Hypnosis	Potentially Eligible	Provider’s statement required. Hypnosis may qualify if performed by a licensed professional to treat a medical condition (e.g., smoking cessation or weight loss due to a diagnosed medical condition). Hypnosis does not qualify if performed for personal well-being, such as general stress relief.
I
Incontinence Supplies	Yes
Insurance Co-Pays	Yes	The flat dollar amounts paid for medical services by the program participant.
Insurance Deductibles	Yes	The portion of a medical claim that is not covered by a health insurance provider and must be paid by the program participant.
Insurance Premiums • Any medical, dental or vision insurance premium (HMO, DMO, PPO, etc.) • Long-term care insurance premium • Medicare (parts A, B & D) • Life insurance • Disability insurance premiums • Student health fees • COBRA premiums	Yes
J
Joint Supplements	Yes
L
Laboratory Fees • Blood tests • Cardiographs • Metabolism test • Stool exams • Spinal test • Urinalysis • X-ray exams • Pap smears • Cholesterol test • Thyroid profile • Storage fees for blood taken for surgery in the near future (not long-term storage) • Laboratory handling fees • Shipping and transport fees This list is not exhaustive.	Yes
Lactose Intolerance Supplements	Yes
Lead-based Paint • Removal of paint • Covering of paint	Potentially Eligible	Provider’s statement required. The cost of repainting the scraped area is not an eligible expense.
Legal Fees for Medical Care Authorizing Treatment for Mental Illness	Yes	Fees related to guardianship or estate management are not eligible expenses.
Lice Treatment	Yes
Lodging (Hospital or Similar Institution) • Hospital • Nursing home • Rehabilitation facility	Yes	Lodging at a hospital or similar institution is an eligible expense if the primary reason for being there is to receive medical care.
Lodging (Non-Hospital) • Hotel • Motel	Potentially Eligible	The cost of lodging not provided in a hospital or similar institution while away from home is an eligible medical expense if: • the lodging occurred at the same time as the medical treatment; • the lodging is primarily for and essential to medical care; • medical care is provided by a doctor in a licensed hospital or medical care facility equivalent of, a licensed hospital; • the lodging is not lavish or extravagant under the circumstances; and • there is no significant element of personal pleasure, recreation, or vacation in the travel away from home
M
Marijuana	No	Payments for medications or treatments illegal in the United States are ineligible for reimbursements. State law does not supersede federal law (e.g., California marijuana dispensaries).
Maternity • Childbirth prep classes (Lamaze) • New parent/Newborn childcare classes • Midwife fees • Maternity girdles (for back pain) or special support hose (for leg circulation) • Home pregnancy tests • Ovulation kits • Doula fees • Lactation consultants	Yes
Meals • Hospital • Nursing home • Rehabilitation facility	Yes	Meals at a hospital or similar institution are eligible expenses if the main reason for being there is to receive medical care.
Medical Alert • Medical alert bracelet • Medical alert systems	Yes
Medical Information • Electronic maintenance of medical plan info • Fees to transfer records due to a change in physicians	Yes
Medical Supplies Bandages Back braces or supports Blood pressure kit Cholesterol testing kit Corn-removal treatments or pads Diabetic supplies Educational materials related to a diagnosed illness First aid kit Glucose kit Heating pad/pack, ice pack Inclinator Orthopedic shoes Orthopedic shoe inserts, or orthotics Physician’s scales Special mattress Surgical stockings Thermometers Truss Wheelchairs, walkers, canes, crutches This list is not exhaustive.	Yes
Mental Health Services	Yes	See Therapy.
Migraine Relief (e.g. Advil Migraine, Motrin Migraine, Excedrin)	Yes
Motion Sickness (e.g. Dramamine, Marezine)	Yes
N
Nursing Home	Yes
Nursing Services • Wages and other fees paid for nursing services • Extra rent or utility expenses for a participant to move into a larger residence with extra space (bedroom) for a nurse or private attendant	Yes
Nutritional Supplements • Vitamins • Minerals	Yes
O
Optician/Optometrist Fees	Yes
Orthodontics	Yes
Over-the-Counter Drugs	Yes	See Drugs/Medicines – Over-the-Counter.
Over-the-Counter Hormone Therapy	Yes
Oxygen • Oxygen tanks • Oxygen equipment	Yes
P
Pain Relief e.g. Advil, Aleve, Aspirin, Ibuprofen, Motrin, Naprosyn, Naproxen	Yes
Pedometer	Potentially Eligible	Provider’s statement required.
Penile Implants	Potentially Eligible	Provider’s statement required. A penile implant is an eligible expense only if impotence is due to organic causes such as trauma, post-prostatectomy, or diabetes.
Personal Hygiene Products • Toothpaste, toothbrush, mouthwash, floss • Deodorant • Shampoo, conditioner, hair spray • Bath soap, hand soap • Shaving cream	No
Prescription Drugs	Yes	Prescription drugs are an eligible expense if prescribed by a doctor and legally purchased in the United States.
Prescription Drug Additives • Additives used to improve the taste of medicine	No
Prosthesis	Yes
Psychiatric Care	Yes
Psychoanalysis	Yes
Psychologist	Yes
R
Radiology Fees • X-Rays • CT Scan • MRI This list is not exhaustive.	Yes
Radon Mitigation	Yes
Rehydration Products (e.g. Pedialyte)	Yes
S
Sales Tax or Shipping & Handling	Yes	Costs for sales or state-mandated taxes and shipping or handling fees associated with an eligible expense; e.g., shipping and handling fees for lab work and other specimens, donors, etc.
Service Animals for Disabled Persons • Cost of the animal • Care of the animal	Potentially Eligible	Provider’s statement required.
Sinus Products • (e.g. 4-Way, Vicks, Allergy Buster)	Yes
Sleeping Aids (e.g. Unisom)	No
Smoke Detector for Disabled Persons	Yes
Smoking Cessation (e.g. Commit, Nicoderm CQ, Nicorette, Nicotrol)	Yes
Snoring Cessation Aids	Yes
Special Education for Disabled Persons • Tuition • Lodging • Meals • Tutoring fees	Potentially Eligible	Provider’s statement required. The cost of a school for a mentally impaired or physically disabled person is an eligible expense if the primary reason is to treat or relieve the disability. (e.g., school for the visually impaired; lip reading to the hearing impaired; or remedial language training to correct a condition caused by a birth defect). The cost of a boarding school while recuperating from an illness is not an eligible expense.
Special Foods/Diet (e.g. Sugar free, Fat free, Gluten free, Diabetic, Low cholesterol)	No	See Weight Loss Products for separate eligibility rules.
Speech Therapy	Potentially Eligible	Provider’s statement required.
Sterilization/Sterilization Reversal • Vasectomy • Tubal ligation	Yes
Stop-Smoking Program or Tools	Yes
Sunburn Relief	Yes
Sunscreen	Yes
Surrogate Pregnancy • Donor’s medical expenses • Surrogate’s medical expenses	Yes
Swimming Pools or Whirlpools	Potentially Eligible	Provider’s statement required.
Surgery, Non-Cosmetic	Yes
Sun-Protective Clothing	Potentially Eligible	Provider’s statement required. Sun-protective clothing used for general health or personal reasons is not eligible.
T
Tanning Bed	Potentially Eligible	Provider’s statement required.
Telehealth, Telemedicine • Medical consultation via electronic communication technology such as live video, text message, email	Yes
Telephone for Disabled Persons • Purchase price of special equipment • Repair of special equipment	Yes	The cost of the telephone is not eligible. An eligible expense would only include special modifications needed for a disabled person to use the telephone.
Television for Disabled Persons • Purchase price of special equipment • Repair of special equipment	Yes	The cost of the television is not eligible. An eligible expense would only include special modifications needed for a disabled person to use the television
Therapy • Physical therapy • Occupational therapy • Chiropractor fees • Massage therapy • Hydrotherapy • Hypnotherapy • Radiation therapy • Chemotherapy • Counseling • Telephone counseling • Marriage counseling	Yes	See Speech Therapy for separate eligibility rules.
Toothache/Teething Relief	Yes
Topical Steroids (e.g. Hydrocortisone)	Yes
Transcutaneous Electrical Nerve Stimulation (TENS) Unit	Yes
Transplants, Organ or Tissue • Surgical, hospital, laboratory, and transportation fees • Cost to transfer medical records in order to find organ donors	Yes
Transportation for Medical Care • Mileage and gas for personal automobile • Plane fare • Ambulance service • Transportation for companion if accompanying a patient who is unable to travel alone • Transportation for regular visits to see a mentally ill dependent if visits are recommended as part of the treatment • Transportation to alcohol or drug rehabilitation meetings • Transportation to pharmacy to purchase eligible expenses • Transportation to provider for medical treatment	Potentially Eligible	Transportation expenses may be reimbursed when the transportation is primarily for, and essential to, medical care. Documentation must accompany the claim to support its relation to medical care. For reimbursement for mileage for personal automobile, the following information must be included with the request: • Dates of travel • Number of miles traveled • Provider’s name • Provider’s address • Receipt or invoice for medical services corresponding to dates of travel The mileage reimbursement rate is determined by the IRS, which is subject to change. The current IRS mileage rate may be found on the IRS website at www.irs.gov. For reimbursement for plane, train, taxi, ridesharing (e.g. Uber, Lyft), metro/subway, ferry, or bus fare, the following information must be included with the request: • Dates of travel • Provider’s name • Provider’s address • Receipt or invoice for medical services corresponding to dates of travel • For international travel or travel outside your home state: Provider’s statement required The following are not eligible transportation expenses: • General repair, maintenance, depreciation, or insurance expenses for personal automobile • Transportation to and from work • Travel to another city if the primary purpose for the travel is not related to medical care, such as a vacation or trip to visit relatives. See Ambulance Service for separate eligibility rules.
Tuition Fees	Potentially Eligible	See Special Education for Disabled. Tuition fees paid to a private school as a personal preference over public schooling for general education are not eligible medical expenses
U
Umbilical Cord Storage	Yes
V
Vacations	No
Vaccinations	Yes
Vitamins and Minerals	Yes
W
Wart Removal • Wart removal treatment performed in a provider’s office • Over-the-counter wart removal treatments (e.g. Compound W)	Yes
Water Bed	Potentially Eligible	Provider’s statement required.
Weight Loss Products	Potentially Eligible	Provider’s statement required. Any weight loss product purchased for purposes of improving one’s general health (without obesity or medical condition), and food or beverage products purchased for weight control or reduction are not eligible.
Weight Loss Program	Potentially Eligible	Provider’s statement required. The weight loss program must treat a medical condition diagnosed by a health care provider (e.g., obesity, diabetes, high blood pressure). Only program fees are eligible. The cost of food for use in weight loss treatment programs is not an eligible expense. The cost of a weight loss program to improve your general health and appearance is not an eligible expense.
Wheelchair Purchase price of wheelchair • Operating cost of wheelchair • Wheelchair cushions	Yes
Wigs or Toupees	Potentially Eligible	Provider’s statement required. A wig or toupee can be an eligible expense if it is necessary to treat a medical condition or improve a deformity that arises from, or is directly related to, a birth defect, a disfiguring disease or an injury resulting from an accident or trauma. Treatment for hair loss that occurs as a normal part of aging or inherited or genetic baldness, or for cosmetic purposes, would not be covered.
X
X-Ray Fees	Yes

SF Medical Reimbursement Account (SF MRA)