Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for visits to your primary care physician.

Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for visits to specialists (e.g. cardiologists, urologist, gynecologist, oncologist, neurologist, etc.)

Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for hospitalization, emergency room visits, and surgery (non-cosmetic only).

Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for counseling and therapy to treat a specific medical condition (e.g. psychotherapy, behavioral therapy, addiction counseling, physical therapy, massage therapy, etc.)

Amount you expect to pay out-of pocket for maternity care or infertility treatments for yourself, a spouse or dependent.

Amount you expect to pay out-of-pocket for chiropractic office visit or acupuncture services.

Your expected annual out-of-pocket costs (including copays and coinsurance) for prescription medications.

Your expected annual costs of OTC medications (e.g. pain relievers, cold medicine, antacids, acne cream, nicotine patches, etc.) As of January 1st, 2011 most OTC medications are only FSA eligible with a doctor’s prescription. Got one? Send it to us and we’d be happy to apply it to your order. If not, simply pay with any regular credit card.

Your expected annual costs of OTC medical supplies. Many OTC medical supplies, such as ( first aid supplies, baby care supplies, breastfeeding and lactation supplies, diabetes care supplies, home health care supplies, eye care supplies etc.) are still FSA eligible. Did you know sunscreen and multivitamins are also FSA eligible? Browse FSAstore.com for the largest selection of exclusively FSA eligible items around!

Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for cleanings, x-rays, fluoride treatments, etc.

Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for fillings, bridgework, crowns, root canals, extractions, implants, etc.

Amount you expect to pay out-of-pocket (including copays, coinsurance and deductibles) for braces, retainers, etc.

Amount you expect to pay out-of-pocket for routine eye care, such as eye exams, glaucoma testing, etc.

Amount you expect to pay out-of-pocket for glasses, sunglasses and contacts prescribed by a doctor. They are all FSA eligible.

Amount you expect to pay out-of-pocket for laser corrective eye surgery. Both LASIK and PRK are FSA eligible.