Health Savings Account (HSA) Eligible Expenses

Health Savings Account (HSA) Eligible Expenses
Make your money work for you now or save money for future healthcare needs.
Eligible HSA Expenses*
Health Savings Account (HSA) funds can be used for hundreds of qualified medical, dental, vision,
prescription, over-the-counter medications and some health insurance deductibles and coinsurance.
HSA funds may even be used for qualified expenses for your spouse or tax dependents. These expenses
include the following:
Medical Expenses
Doctor visits, laboratory tests, medical equipment, and
hospital services. Examples include:
Provider Visits & Care
Acupuncture
Chiropractic care
Christian Science practitioner
Fertility treatment
Nursing services
Diagnostic & Preventive Care
Flu shot and immunizations
Laboratory fees
Medical testing device
Obstetrical expenses
Physical exam
Programs & Treatments
Alcoholism treatment
Drug addiction treatment
Insulin
Oxygen
Physical therapy
Psychiatric care
Smoking cessation program
Surgery
Weight loss program for obesity treatment (if prescribed
by a physician)
Medical Equipment, Support & Transportation
Artificial limb
Automobile modifications for a physically
handicapped person
Blood pressure monitoring device
Braille books and magazines (above the cost of regular
printed material)
Crutches
Guide dog or other animal aid
Hearing aids
Transportation for medical care
Wheelchair
Hospital Services & Visits
Ambulance
Anesthesia
Hospital room and board
Organ transplant
Dental Expenses
Non-cosmetic dental treatments. Examples include:
Crowns
Dentures
Diagnostic services
Fillings
Orthodontia (not for cosmetic reasons)
Teeth cleaning
Tooth extraction
Vision Expenses
Eye doctor appointments and vision correction materials.
Examples include:
Contact lenses, eye glasses and related materials
Eye drops
Eye examinations
Laser eye surgery
Prescription Expenses
All legally obtained prescriptions, including any prescribed
over-the-counter medications. Examples include:
Allergy preventions/treatments
Antacids and acid reducers
Birth control pills
Cold and flu medicines
Cold sore remedies
Decongestants
Oral pain relievers
Orthopedic shoe inserts
Pain and fever relievers
Sinus medications
Snoring cessation aids
Vitamins, herbal and fiber supplements
Weight loss and dietary supplements
(continued on reverse side)
Note: You can only use funds up to the current balance
in your account.

Over-The-Counter Medications
and Treatments
The new healthcare reform law significantly changes your
over-the-counter (OTC) benefits. Effective January 1, 2011,
you may only use your healthcare payment card to purchase
OTC drugs and medicines if you have a physician’s
prescription at a retail establishment, such as a pharmacy,
that meets IRS standards.
Based on communications from a trade association of
healthcare payment card companies, we believe that you
may use your healthcare payment card at retail
establishments that meet IRS standards for a limited number
of purchases without a prescription. Examples include:
Antiseptics and wound cleansers
Bandages and dressings
Contact lens solution and eye care related drops
Contraceptives
Denture adhesives, repair, pain relief and cleansers
Diagnostic products (thermometer, blood pressure monitor,
cholesterol testing)
Ear care
First aid burn remedies, dressings and supplies
Foot care antifungal and treatments
Hearing aid/medical batteries
Home health care (limited segments)
Incontinence protection and treatment products
Insulin
Reading glasses and maintenance accessories
A Note about Insurance
Premium Expenses
Some health insurance premiums are considered qualified
expenses. Call 800-941-6121 for more information.
Examples include:
COBRA premiums
Long term care insurance premiums
Retiree medical insurance premiums
Ineligible HSA Expenses
Expenses merely beneficial to general health or for
cosmetic reasons are not qualified. Examples include:
Cosmetic surgery
Cosmetics
Deodorant
Exercise equipment
Fitness programs
Funeral expenses
Hair transplants
Household help
Illegal operations and treatments
Insurance premiums
Maternity clothes
Moisturizers and wrinkle creams
Sun tan lotions
Teeth whitening services and products
Toothpaste, toothbrushes and mouth wash
Vitamins taken to improve overall health
Go to premera.com or call 800-941-6121 for more information about your
Health Savings Account and qualified expenses.
* For more detailed information, refer to IRS Publication 969, “Health Savings Accounts and Other Tax-Favored Health Plans,” which you can
download from the IRS Web site, www.irs.gov, or order by calling 1-800-TAX FORM. This material is not intended to be tax or legal advice. The
reader should consult with his or her own tax advisor to determine the tax implications of participating in a personal funding account discussed
herein. Advice, if any, included in this material was not intended or written by Premera to be used, and it cannot be used, by any taxpayer for the
purpose of avoiding penalties that may be imposed on the taxpayer.
022856 (12-2010)