SF Covered Medical Reimbursement Account (SF Covered MRA)

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.

    1. Find the health care expense.
    2. 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.
    3. 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. We included a Provider’s Statement Form on the last page of this guide if you need a form for your provider to complete.
HEALTH CARE EXPENSE TYPEELIGIBLE FOR
REIMBURSEMENT
SPECIAL REQUIREMENTS
A
AA, Alcoholism, Drug, or
Substance Abuse Treatments

• Alcohol or substance abuse treatment
center, including meals and lodging
Yes
AbortionYes
Acne Treatment
• Acne medication
• Acne peels
• Cryosurgery
• Dermabrasion
• Laser Treatment
Yes
Activity TrackerPotentially EligibleProvider’s statement required
Acupuncture
• Acupuncture
• Acupressure
Yes
Adoption FeesNoYou 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) PenaltiesNoTax 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 EligibleProvider’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 EligibleProvider’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 ServicesYes
Anti-Itch Lotions and CreamsYes
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
YesSee also Fertility Treatments
Artificial Limb (prosthesis) or
Teeth (dentures or implants)
Yes
Asthma MedicinesYes
Audio Books
• Books on tape
• Books on CD
• Books online or other digital formats
Potentially EligibleDocumentation 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 EligibleProvider’s statement required.
B
Baby FormulaYes
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 StorageYes
Body Scan
• CT body scanning
• Full body scanning
Yes
Botox TreatmentPotentially EligibleProvider’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 OrthodonticsYes
Braille Books and MagazinesYes
Breast Pumps and Related SuppliesYes
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 EligibleOnly 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 FeesYes
Christian Science PractitionersYes
Church of Scientology PractitionersNo
CircumcisionPotentially EligibleFees for “ritual” circumcision performed by a
non-health care provider (e.g., rabbi, mohel)
are not eligible.
Classes, Health-RelatedPotentially EligibleProvider’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 TreatmentYes
Colonic Cleansing/WashNo
Concierge (Boutique) FeesYesMembership or retainer fees to a provider for eligible health care services.
CondomsYes
Contact Lenses and
Contact Lens Cleaner
Yes
Contraceptive ProductsYesSee Birth Control / Family Planning.
CopaymentsYesSee Insurance Co-Pays.
Cord StorageYes
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 EligibleProvider’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
CrutchesYes
D
Dancing or Swimming Lessons, etc.No
Decongestants
(e.g. Claritin-D, Neo-Synephrine, Sudafed)
Yes
DeductiblesYesSee 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 EligibleProvider’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 ServicePotentially EligibleDiapers 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.
YesFees 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 – PrescriptionsYesExpenses 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, Potentially Eligible
Drug Addiction TreatmentYes
E
Electrolysis or Hair RemovalPotentially EligibleProvider’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 EligibleProvider’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 DropsYes
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
YesThe 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 SupplementsYes
First Aid Supplies/Wound Care
(e.g. Band-Aids, Neosporin)
Yes
Fitness Tracking DevicePotentially EligibleProvider’s statement required.
Fluoride Treatments
(e.g., fluoride rinses)
Yes
Food Supplements
(e.g. Ensure, Pediasure)
Yes
Funeral ExpensesNo
G
Gender Re-Assignment
• Surgery
• Counseling
• Hormone therapy
Yes
Genetic TestingPotentially EligibleProvider’s statement required.
Guide Dogs
• Cost of the animal
• Care of the animal
Potentially EligibleProvider’s statement required.
Gym Fees
• Gym Membership Fees
• Gym Class/Trainer Fees
Potentially EligibleProvider’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 TreatmentPotentially EligibleProvider’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 TransplantPotentially EligibleProvider’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 DuesPotentially EligibleProvider’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 EligibleProvider’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 PremiumsYesSee Insurance Premiums.
Health Screenings or Routine Medical
Exams
(e.g. VDRL, cholesterol, diabetes
glucose, blood pressure)
Yes
Healthy San Francisco Participant FeesPotentially EligibleEligible 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
YesThe 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 ExamsYes
Heart MonitorsPotentially EligibleProvider’s statement required.
Monitors tracking heart rate during exercise
for general purposes not eligible.
Hemorrhoidal PreparationsYes
Hippotherapy
Therapeutic horseback riding
Potentially EligibleProvider’s statement required.
Recreational horseback riding is not an
eligible expense.
Home for Mentally Disabled PersonsYesThe 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 ModificationPotentially EligibleSee Capital Modification.
Household Help
• Cleaning services
• Cook/chef
• Personal assistant
• Driver
• Gardener
NoCertain expenses paid to an attendant
providing nursing type service may be eligible.
See Nursing Services.
Human Chorionic Gonadotropin (HCG)
Injections
Potentially EligibleProvider’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.
HypnosisPotentially EligibleProvider’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 SuppliesYes
Insurance Co-PaysYesThe flat dollar amounts paid for medical
services by the program participant.
Insurance DeductiblesYesThe 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 SupplementsYes
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 SupplementsYes
Lead-based Paint
• Removal of paint
• Covering of paint
Potentially EligibleProvider’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
YesFees related to guardianship or estate
management are not eligible expenses.
Lice TreatmentYes
Lodging
(Hospital or Similar Institution)

• Hospital
• Nursing home
• Rehabilitation facility
YesLodging 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 EligibleThe 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
MarijuanaNoPayments 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
YesMeals 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

  1. Bandages
  2. Back braces or supports
  3. Blood pressure kit
  4. Cholesterol testing kit
  5. Corn-removal treatments or pads
  6. Diabetic supplies
  7. Educational materials related to a
    diagnosed illness
  8. First aid kit
  9. Glucose kit
  10. Heating pad/pack, ice pack
  11. Inclinator
  12. Orthopedic shoes
  13. Orthopedic shoe inserts, or orthotics
  14. Physician’s scales
  15. Special mattress
  16. Surgical stockings
  17. Thermometers
  18. Truss
  19. Wheelchairs, walkers, canes, crutches
    This list is not exhaustive.
Yes
Mental Health ServicesYesSee Therapy.
Migraine Relief
(e.g. Advil Migraine, Motrin Migraine,
Excedrin)
Yes
Motion Sickness
(e.g. Dramamine, Marezine)
Yes
N
Nursing HomeYes
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 FeesYes
OrthodonticsYes
Over-the-Counter DrugsYesSee Drugs/Medicines – Over-the-Counter.
Over-the-Counter Hormone TherapyYes
Oxygen
• Oxygen tanks
• Oxygen equipment
Yes
P
Pain Relief
e.g. Advil, Aleve, Aspirin, Ibuprofen,
Motrin, Naprosyn, Naproxen
Yes
PedometerPotentially EligibleProvider’s statement required.
Penile ImplantsPotentially EligibleProvider’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 DrugsYesPrescription 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
ProsthesisYes
Psychiatric CareYes
PsychoanalysisYes
PsychologistYes
R
Radiology Fees
• X-Rays
• CT Scan
• MRI
This list is not exhaustive.
Yes
Radon MitigationYes
Rehydration Products
(e.g. Pedialyte)
Yes
S
Sales Tax or Shipping & HandlingYesCosts 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 EligibleProvider’s statement required.
Sinus Products
• (e.g. 4-Way, Vicks, Allergy Buster)
Yes
Sleeping Aids
(e.g. Unisom)
No
Smoke Detector for Disabled PersonsYes
Smoking Cessation
(e.g. Commit, Nicoderm CQ,
Nicorette, Nicotrol)
Yes
Snoring Cessation AidsYes
Special Education for Disabled Persons
• Tuition
• Lodging
• Meals
• Tutoring fees
Potentially EligibleProvider’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)
NoSee Weight Loss Products for separate eligibility rules.
Speech TherapyPotentially EligibleProvider’s statement required.
Sterilization/Sterilization Reversal
• Vasectomy
• Tubal ligation
Yes
Stop-Smoking Program or ToolsYes
Sunburn ReliefYes
SunscreenYes
Surrogate Pregnancy
• Donor’s medical expenses
• Surrogate’s medical expenses
Yes
Swimming Pools or WhirlpoolsPotentially EligibleProvider’s statement required.
Surgery, Non-CosmeticYes
Sun-Protective ClothingPotentially EligibleProvider’s statement required.
Sun-protective clothing used for general
health or personal reasons is not eligible.
T
Tanning BedPotentially EligibleProvider’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
YesThe 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
YesThe 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
YesSee Speech Therapy for separate eligibility rules.
Toothache/Teething ReliefYes
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 EligibleTransportation 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 FeesPotentially EligibleSee 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 StorageYes
V
VacationsNo
VaccinationsYes
Vitamins and MineralsYes
W
Wart Removal
• Wart removal treatment performed in a
provider’s office
• Over-the-counter wart removal
treatments (e.g. Compound W)
Yes
Water BedPotentially EligibleProvider’s statement required.
Weight Loss ProductsPotentially EligibleProvider’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 ProgramPotentially EligibleProvider’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 ToupeesPotentially EligibleProvider’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 FeesYes