Health Care Spending Account Examples

Provided below are links to PDF files containing examples of eligible and ineligible expenses for both (1) health care flexible spending accounts and (2) dependent care flexible spending accounts. Please remember: For each expense, you must submit documentation from the provider or a third party that includes the following:

• Date
• Amount
• Provider
• Type of service

Some expenses may require additional documentation to establish eligibility, such as a physician's statement that a certain expense will treat your existing medical condition.

View listings of eligible and ineligible expenses for

• Health care flexible spending account (PDF)
• Dependent care flexible spending account (PDF)