Eligible Medical Expenses

Funds and Reimbursements
Written By Jeremy Dunn

This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement).*

Generally, the IRS Tax Code 213(d) determines eligible reimbursable expenses. (For more information, see the IRS publication 502.) However, your former employer might not include all 213(d) expenses as eligible for reimbursement from your reimbursement account. Each employer establishes its own guidelines regarding eligible expenses for which it allows reimbursement. This information is available:

  • In your summary plan description (SPD)

  • By viewing eligible expenses in your account

 

  • By contacting Via Benefits

  • In the Reimbursement Guide Via Benefits sends you within two weeks of your plan's effective date

If you think something may be reimbursable based on this information, submit a reimbursement request. To learn how to submit a request, read Submitting a Reimbursement Request. Your request will be paid or denied according to your reimbursement account's rules. If it’s denied, you'll be sent an Explanation of Payment (EOP) or an Explanation of Unpaid Expenses (EOUE). The statement provides instructions on what to provide, such as a Letter of Medical Necessity, so your request may be reprocessed. It may also tell you no further action is necessary. If tax advice is required, please seek the services of a tax professional. 

Eligible Expenses

Premiums

Your funding program may allow for reimbursement for your eligible premium expenses to the degree that funds are available. As long as it's an eligible premium, you can apply the funds provided in your reimbursement account toward post-tax premium expenses incurred while you're eligible for your funding program. Generally, you pay your insurance premiums to the insurance carrier every month before requesting reimbursement.

  • Medical

    • Medicare Supplement (Medigap)

    • Medicare Advantage

    • Individual and Family Plans (Marketplace plans)

    • Short-Term Medical

  • Hearing

  • Medicare Parts A and B

  • Prescription Drug

  • Dental

  • Vision

  • Long-Term Care

Out-of-Pocket Expenses

Your funding program may allow for reimbursement for your eligible out-of-pocket health care expenses to the degree that funds are available. Out-of-pocket expenses include copayments, deductibles, and coinsurance payments. This list provides a sample of eligible expenses for reimbursement based on IRS Code Section 213(d).

  • Medical

    • Doctor

    • Chiropractor

    • Hospital bills

    • Diagnostic testing

      • Lab work

      • X-rays

    • Physical, occupational or speech therapy

    • Oxygen and oxygen equipment

    • Medical equipment and repair

      • Wheelchair

      • Walker

      • Crutches

      • CPAP equipment and supplies

    • Vaccinations and immunizations

    • Transportation expenses for medical care

      • Ambulance

      • Personal vehicle mileage

      • Transportation service

        • Bus, train, taxi, ride share services, parking

  • Over-the-counter

    • Diabetic supplies and testing equipment

    • First aid supplies

  • Adult incontinence supplies

  • Pharmacy

    • Over-the-counter medicines

  • Dental

    • Examination, cleaning, and X-rays

    • Treatment

    • Oral surgery

    • Dentures and implants

  • Vision

    • Eye examinations

    • Eye glasses and contacts

  • Hearing

    • Hearing aids

    • Hearing aid batteries and repairs

Non-Reimbursable Expense Examples

This list includes some common health care expenses that may not be eligible for reimbursement under your specific funding program. For more information on eligible expenses covered by your particular plan, refer to your SPD, view eligible expenses using your account via the website, or contact Via Benefits.

  • Premiums for life insurance, critical illness,
    income protection, or disability insurance

  • Premiums for cost sharing insurance (health care
    sharing ministries, Medi-Share)

  • Premiums paid on a pre-tax basis before taxable wages are calculated, such as those paid for employer-provided group health insurance

  • Cosmetic procedures

  • Medical marijuana or CBD products

  • Weight loss programs, food and beverages

  • Assisted living or long-term care expenses

    • Cost of medical care provided by the facility
      may be reimbursable

  • Household help

  • Gym memberships+

  • Dietary supplements+

+Unless a documented medical necessity

*Via Benefits reimbursement accounts are administered by Extend Health, LLC.

Jeremy Dunn
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