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Know Your FSA /HSA Eligible and Ineligible Expenses Maximize the Value of Your Reimbursement Account
Your Flexible Spending Account (FSA) and Health Savings Account (HSA) dol ars can be used for a variety of out-of-pocket health care expenses. Take a look at the fol owing lists for a better understanding of what is and is not eligible. Eligible Expenses BABY/CHILD TO AGE 13
MEDICAL EQUIPMENT/SUPPLIES
MEDICATION
 Lactation Consultant*  Air Purification Equipment*  Lead-Based Paint Removal  Arches,Orthotic Inserts and  Prescription Drugs  Special Formula* Orthopedic Shoes  Tuition: Special School/Teacher  Contraceptive Devices OBSTETRICS
for Disability or Learning  Crutches and Wheel Chairs  Lamaze Class  Exercise Equipment*  Midwife Expenses  Well Baby Care  Hospital Beds  OB/GYN Exams  Medic Alert Bracelet or Necklace  OB/GYN Prepaid Maternity Fees (reimbursable after date of birth)  Dental X-Rays  Pre- and Postnatal Treatments  Dentures and Bridges  Post-Mastectomy Clothing  Breast Pumps and Lactation  Exams and Teeth Cleaning  Extractions and Fil ings  Oral Surgery  Orthodontia and Braces  Crowns and Root Canals MEDICAL PROCEDURES/SERVICES
 Chiropractor  Periodontal Services  Christian Science Practitioner  Alcohol and Drug Addiction  Dermatologist (inpatient and outpatient  Homeopath or Naturopath*  Artificial Eyes  Eyeglasses and Contact Lenses  Hospital Services  Psychiatrist or Psychologist  Laser Eye Surgeries  Fertility Enhancement and  Prescription Sunglasses  Radial Keratotomy/LASIK  In Vitro Fertilization  Alcohol and Drug Addiction  Physical Examination  Counseling (not marital or (not employment-related)  Hearing Devices and Batteries  Reconstructive Surgery (due to a congenital defect or accident) Hearing Examinations  Service Animals* LAB EXAMS/TESTS
 Sterilization/Sterilization Reversal  Occupational Blood Tests and Metabolism Tests Transplants (including organ  Transportation*  Weight Loss Programs* Vaccinations and Immunizations  Smoking Cessation Programs* Note: This list is not meant to be all-inclusive, as other expenses not specifically mentioned may also qualify. Also, expenses marked with
an asterisk (*) are "potential y eligible expenses" that require a Note of Medical Necessity from your health care provider to qualify for reimbursement. For additional information, contact Stanley Benefits. The IRS allows certain over-the-counter (OTC) medicines to be reimbursed using your FSA/HSA dollars.
Here is a brief listing of some of those items:
Stanley Benefits, P.O. Box 29329 Greensboro, NC 27429-9329
Phone: 877-727-3539 - Fax: 877-432-9247 - Email:- Web:
Eligible Over-the-Counter Items in these categories can be purchased with a Benny card and without a prescription  Baby Electrolytes
Ear Care (non-medicated)
First Aid Dressings and Supplies
Pedialyte, Enfalyte Ear drops, syringes, ear wax Band Aid, 3M Nexcare,  Contraceptives/Family
Planning
Elastics/Athletic Treatments
Glucosamine and/or Chondroitin
Non-medicated condoms ACE, Futuro, elastic bandages, (arthritis treatment)
Denture Adhesives, Repair,
braces, hot/cold therapy, Osteo-Bi-Flex, Cosamin D, Flex-a-min and Cleansers
orthopedic supports, rib belts  Hearing Aid/Medical Batteries
PoliGrip, Benzodent, Efferdent Unless classified as "sport" or Incontinence Products
Diabetes Testing and Aids
Attends, Depend, GoodNites for juvenile Insulin, Ascencia, One Touch,
incontinence, Prevail Diabetic Tussin, insulin syringes; Contact lens care Prenatal Vitamins
glucose products  Family Planning
Stuart Prenatal, Nature's Bounty  Diagnostic Products
Pregnancy and ovulation kits prenatal Vitamins Thermometers, blood pressure  Foot Treatment
Reading Glasses and Maintenance
monitors, cholesterol testing Unmedicated corn and cal us Accessories
treatments: (e.g.,callus cushions), devices, therapeutic insoles Sunscreen 15 SPF or greater
Prescription Required Over-the-Counter Items
No te: These products may only be purcha sed using the Benny Card if the pharmacy assigns a RX number. A dispensing fee
(which is flex eligible) may be added. Oth
erwise, send the prescription and receipt to St anley Benefits for manual
reimbursement. Sta
nley will retain the Prescription on File for
refills.
Acne Medications
Laxatives (non-fiber)
Clearasil, OXY Denture Pain Relief
Motion Sickness
Nasal Sprays, Drops and
Acid Controllers/Digestive
Digestive Aids
Inhalers
Ear Care
Afrin Spray, Ocean Nasal Spray  Allergy and Sinus Medicine
Eye Care
Oral Remedies or Treatments
Antibiotics
Feminine Anti-Fungal/Anti-itch
Mouth sore treatments  Anti-Diarrhea Medicine
Fiber Laxatives (bulk forming)
Pain Relievers
Antifungal (foot)
First Aid Burn Remedies
Lamisil, Lotrimin Respiratory Treatments
Dermoplast, Solarcaine  Skin Treatments (for eczema,
Anti-Gas Products
Hemorrhoidal Preps
psoriasis, rosacea, etc.)
Anti-Itch and Insect bite
Foot Care Treatments
Psoriasin, MG217, Dermarest  Anti-Parasitic Treatments
Corn and cal us treatments,  Antiseptics, Wound Cleansers
wart removers, devices,  Sleep Aids and Sedatives
Alcohol, peroxide, Epsom salt, Homeopathic Remedies
Smoking Deterrents
(products that treat an illness
Nicoderm, Nicorette  Baby Teething Pain
or condition)
Stomach Remedies
Baby Orajel, Anbesol Baby Oral Gel Boiron and Hyland products  Cold, cough and Flu
Incontinence protection and
treatment products
Ineligible Expenses
The IRS does not allow the following expenses to be reimbursed under FSA's/HSA's, as they are not prescribed by a
physician for a specific ailment.
Baby-sitting and Child Care* Personal Trainers Marriage Counseling Insurance Premiums (Eyewear) Hair Loss Medication Maternity Clothes Cosmetic Surgery/Procedures Sunscreen (less than SPF 15) Dancing/Exercise/Fitness Programs* Health Club Dues* Swimming Lessons Insurance Premiums and Interest Teeth Bleaching or Whitening Long-Term Care Premiums (FSA) Nutritional Supplements* Note: This list is not meant to be all-inclusive. Also, expenses marked with an asterisk (*) are "potentially eligible expenses" that require a Note of Medical Necessity from your health care provider to qualify for reimbursement. Stanley Benefits, P.O. Box 29329 Greensboro, NC 27429-9329
Phone: 877-727-3539 - Fax: 877-432-9247 - Email:- Web:

Source: https://www.alphabest.org/wp-content/uploads/2014/11/Eligible-Ineligible-FSA_HSA-10-01-2015.pdf

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e-mail: ahmadloo@sums.ac.ir J Babol Univ Med Sci; 11(3); Aug-Sep 2009 The Effect of Sucralfate in Prevention ; N. Ahmadloo, et al RTOG/ EORTC Kneebone, Martenson J Babol Univ Med Sci; 11(3); Aug-Sep 2009 The Effect of Sucralfate in Prevention ; N. Ahmadloo, et al The Effect of Sucralfate in Prevention of Radiation- Induced Acute Proctitis

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Case 5:08-cv-00479-PD Document 169-1 Filed 05/16/12 Page 1 of 66 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA KYLE J. LIGOURI and TAMMY L. HOFFMAN individually and on behalf of all others similarly situated, CIVIL ACTION NO. 5:08-CV-00479-PD WELLS FARGO & COMPANY, WELLS FARGO BANK, N.A., NORTH STAR MORTGAGE GUARANTY REINSURANCE COMPANY,