Frequently Asked Questions
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Are expenses for orthodontia covered under the FSA?
Orthodontia expenses are eligible under the Health FSA. Most orthodontia is paid in monthly installments. The monthly payments within your plan year are eligible for reimbursement. We require a copy of the financial contract between you and the orthodontist. Also, the down payment is eligible as long as it is billed within your current plan year.
Why wasn't my orthodontia claim paid in full?
Did you provide us with a copy of your contract? Orthodontia expenses are handled a bit differently than any other healthcare type of expense. Orthodontia expenses are pro-rated over the duration of the contract, as long as you provide us with a copy of the contract.
What do I need to submit for my orthodontia claim?
You will need to submit a copy of the orthodontia contract specifying start date, length of treatment, total cost for the treatment and the payment schedule.
My child's retainer has a tooth attached to it. In a couple of years, she will need an implant in another place because that tooth is missing. Is this covered?
Yes, implants are covered as long as they are not for cosmetic purposes.
Is bleaching covered?
No, bleaching is normally for cosmetic purposes and therefore not a covered expense. This is based on Internal Revenue Service guidelines and the IRS is extremely strict on this regulation.
My daughter just got her braces off. She has a retainer with a spacer in it because she has an undersized tooth. The orthodontist says she needs her tooth built up. Is bonding covered?
Bonding is generally not covered since the IRS considers bonding to be a cosmetic expense. However, if there is a true medical necessity for bonding, it may be covered. In addition to the typical receipt showing date, description and dollar amount of service, we would also need a letter from the provider stating that the procedure was medically necessary.
My front top teeth were bonded 14 years ago and need to be redone. Is this an eligible expense?
This depends on if your provider can certify that it is a necessary procedure and that the procedure is not cosmetic in nature. If your provider cannot provide the necessary certification, the IRS generally considers this procedure to be cosmetic and it will not be considered an eligible expense.
What kind of substantiation documents do I need from a medical practitioner?
The documentation must include the name of the person receiving services, description of service, date the service was provided, cost and provider information. A physician's note maybe required for some expenses. A good example would be to recommend that a specific Over the Counter (OTC) drug or supplement be purchased to treat a specific condition. In these cases, we need documentation that an individual has a diagnosed medical condition and that the treatment relates to the condition. This is enough for the expense to qualify as medical care. Please remember that in order for prescription pads to be considered, they must be legible. It they cannot be read, they cannot be accepted.
Is cosmetic surgery covered or any part of it covered?
As a general rule, the IRS does not allow cosmetic surgery - that is a procedure intended only to improve your appearance. However, it typically does allow procedures that are medically necessary, such as surgery to correct a congenital abnormality or to repair damage caused by an accident or trauma.