Entertainment Industry Flex Plan

Medical Reimbursement Guide

The following is only a brief list of some of the items that may and may not be eligible for reimbursement. The IRS Regulations and Rulings establish general rules as to the items that are eligible for reimbursement and those which are not.
Eligible medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes.
Medical expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are for cosmetic purposes or are merely beneficial to general health.
The IRS also provides specific examples of items that are, and are not, eligible for reimbursement. Those specific examples change from time to time as technology and medicine evolve. As the Flex Plan becomes aware of changes to the IRS eligible items list, the following list will be updated. New or updated items will be displayed in bold. Therefore, this list is made available without warranty of any kind. The Flex Plan is not engaged in providing legal, accounting or tax advice. The reimbursement list below is subject to change without notice.
If you are unsure or have any doubt if a specific expense will qualify, please contact the Member Services Department prior to purchasing the item or incurring the service. Please note that in order to receive a reimbursement from the Flex Plan, you must submit a properly completed claim form and supporting documentation as well as have the funds available in your Flex Plan Account (subject to two month premium reserve, if applicable). In addition, to be eligible for reimbursement, claims incurred in a calendar year must be received by the Flex Plan by March 31 of the following year.
Please review all of the Claims Reimbursement Instructions on the Medical Expense Reimbursement Claim Form PRIOR to submitting your claim.
You may check your eligibility and the amount available for reimbursement in the Claims Reimbursement Section of the “On-line Account Access” page.
IMPORTANT: Due to the recently passed CARES Act, effective January 1, 2020, Over-the-Counter Medicines and Drugs are now reimbursable.
Who may write a Prescription?
For the purposes of seeking reimbursement from the Flex Plan, a prescription may only be issued by a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO) licensed in the state they practice.
What must a Letter of Medical Necessity contain?
A Letter of Medical Necessity must be issued by a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO) licensed in the state they practice, and must be a written order for a drug, over-the-counter medicine, device or treatment that is required for medical treatment or care. The Letter of Medical Necessity must include all required information as defined in the Flex Plan Letter of Medical Necessity Template.
Letter of Medical Necessity Template
We have created a template for your Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) to use to assist them in providing the information necessary in a Letter of Medical Necessity. Click here to view or print the template.

The Letter of Medical Necessity must be issued before the expense is incurred and include the following:

  • name of patient,
  • date of issue,
  • name and quantity of the drug, medicine, device or treatment prescribed,
  • prescriber (name, address, telephone, license classification, and federal registry number if applicable),
  • specific medical condition being treated,
  • a statement that the treatment is medically necessary and is not for general health or cosmetic in nature,
  • duration of the treatment (may not exceed one year),
  • prescriber’s signature.