Won't condoms now be considered a reimburseable expense?

[Guest dbutton]

Won't condoms now be considered a reimburseable expense? According to the regs, "medical care" is defined to include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. So, by definition, condoms are for the prevention of disease so they'd be reimburseable, right? Makes sense to me. But aren't they taxable (sales tax) in most places? Would the state taxability change in any way due to this new development?

And what about feminine products??? I've always wondered why they're taxable. I mean, women only buy them because they have to, they're a necessity. But I can't figure out where that would fit in the definition as medical care so I'm guessing not - doesn't seem fair but who am I to argue what's fair. Wait, maybe because if they weren't used it could possibly spread disease, so in a way it's a preventable?

How about Dr. Shoals (or whatever brand) shoe inserts? They affect a structure of the body.

While this post is my pitiful attempt to be lighthearted about this, I just fear so much trouble on the administration side (as most of us are probably feeling). I believe most plan sponsors will wind up with something near an "anything goes" plan.

[g8r]

The expense has to be related to a mental or physical defect or illness. That's why personal items aren't valid expenses (e.g., in Publication 502 a toothbrush and toothpaste aren't allowable).

Using that analysis, you could certainly twist the facts and argue that almost anything goes. For feminie products, it's tough to argue that the primary purpose is to prevent the spread of disease. For condoms, there's possibly a stronger argument, but as you point out, how do you determine whether it's for birth control or for the spread of disease.

These issues aren't new. Most people have just been dealing with these issues using a reasonableness standard. Fortunately, most participants don't think about submitting some of these minor expenses as medical expenses covered by the plan. I guess it's the debit/credit card concerns where much of these issues have come in.

[oriecat]

Well I don't see why condoms shouldn't be a covered expense, altho I fully admit to not brushing up on what all the regs say. If I, as a female, choose to use condoms for birth control, as opposed to the pill, why should one be reimburseable but not the other? Both are for the prevention of the medical condition of pregnancy. Now if you've got men buying the condoms, I can see where that gets a little trickier, since they aren't preventing their own pregnancies, but you do have the disease control issue...

[Guest dbutton]

I attended the EBIA teleconference yesterday on FSA OTC drugs. Condoms are indeed reimburseable. As can incontinence supplies (isn't that similar to feminine products???), bandages, and crutches. However, acne medications like Clearasil are a "might be reimburseable". Acne is usually considered cosmetic. So unless someone has a skin disease that they are using an acne product for, it wouldn't be reimburseable.

They also said that employers are putting in quantity limits to prevent the 100 bottles of aspirin purhcases on 12/31 to use up unused FSA monies. But how do you determine what a good quantity is? Some people/families can go through a bottle of advil a week. Others go through a bottle in a year.

Then there's the whole receipt issue. They said that the receipts had to include the name of the drug, cost, and date. Fine, that makes perfect sense, you don't want to reimburse for someone's weekend Budweiser. But a co-worker pointed out that this seems to be discriminating against the mom & pop drug stores that don't put that info on the receipt. The big chains with the high tech cash registers win again.

Just some more food for thought.

This goes in my too hard pile. I think most plans will wind up being very generous. I mean, it won't be cost effective to have a plan administrator question every receipt that comes in. If the receipt shows a medicine, or something that could possibly be a medicine, then that's enough for payment - move on to the next claim.

I think we'll fewer people leaving forfeitures on the table. Plan expenses are going to go up. Admin headaches are going to go up. Will the advil I buy to take at work due to the headache I'm getting be FSA reimburseable or will I have to file a Worker's Comp claim?

[Lisa Hand]

Section 213(d)(1) defines "medical care" to include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

Feminine products are considered personal use items because they are not treating anything, but rather used for a normal body function. They do not affect that function.

[Ron Snyder]

Acne is a skin disease by definition.

"ac·ne An inflammatory disease of the sebaceous glands and hair follicles of the skin that is marked by the eruption of pimples or pustules, especially on the face.

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[New Latin, probably from misreading of Greek akm, point, facial eruption. See acme.]

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Source: The American Heritage® Dictionary of the English Language, Fourth Edition

Copyright © 2000 by Houghton Mifflin Company.

Published by Houghton Mifflin Company. All rights reserved."

[Guest lschaab]

We denied clearasil gel because the receipt did not contain the term 'medicated' (it was also incurred in a prior plan year). If the participant were to submit a statement from a physician stating the medical condition, we would then accept it. On the other hand, we accepted Oxy Balance Emergency Spot Treatment - Acne Medication because the receipt contained the term 'medication'. Our decision to accept that expense was based on the statement in the ruling "... 1.213-1(e)(1)(ii) also states that expenditures for "medicines or drugs" are expenditures for medical care."

We did not accept mouthwash or toothpaste, but had the great debate on the reason for making these purchases (while also being for personal use) are also for the prevention of gum disease, etc. What about orthopedic pillows, if the reason stated on a claim form is to alleviate back and/or neck pain? Once a participant gets 'smart' as to how to play the game by stating the "Directions for Use:" off the packaging as the reason for purchase then anything goes. Getting doctors notes for everything that comes through the door slows down the processing and increases the level of frustration accross the board. Ugh!