HRA plans reimburse medical expenses that qualify as “medical care” under IRS rules, including most out-of-pocket healthcare costs and eligible insurance premiums, but they exclude non-medical or lifestyle expenses.
Your HRA Employee Packet, available in your Member Portal, includes the definitive list of what is reimbursable under your specific plan. The list below covers IRS-eligible expenses generally — your plan may be configured to cover a subset of these.
QSEHRA & ICHRA must follow guidelines set forth by IRS Publication 502, Medical and Dental Expenses. Below is an excerpt of what is included in the manual. This is not a comprehensive list, but it is a great start to understanding what the IRS considers eligible as a medical expense for tax-free reimbursement.
What medical expenses are reimbursable through an HRA?
You can be reimbursed for medical expenses that are considered “medical care” under IRS Section 213(d), meaning expenses used to diagnose, treat, or prevent a medical condition.
Reimbursable expenses include:
Abdominal supports
Abortion
Acupuncture
Alcoholism treatment
Allergy medications
Ambulance
Anesthetist
Antacids
Anti-diarrhea medicine
Antibiotic ointments
Arch supports
Artificial limbs
Autoette (when used for relief of sickness/disability)
Birth control pills (by prescription)
Blood tests
Blood transfusions
Braces
Breast pumps and supplies
Calamine lotion
Cardiographs
Chiropractor
Cold medicine
Contact lenses
Contraceptive devices (by prescription)
Convalescent home (for medical treatment only)
Cough drops and throat lozenges
Crutches
Dental treatment
Dental X-rays
Dentures
Dermatologist
Diagnostic fees
Diathermy
Drug addiction therapy
Drugs (prescription)
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute prescribed by a doctor
First aid creams
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lodging (away from home for outpatient care)
Menstruation Products
Metabolism tests
Motion sickness pills
Neurologist
Nicotine medications and nasal sprays
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor’s expenses)
Orthodontics
Orthopedist
Osteopath
Oxygen and oxygen equipment
Pain relievers
Pedialyte
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Sinus medications and nasal sprays
Sleep aids
Spinal fluid test
Splints
Sterilization
Suppositories and creams for hemorrhoids
Surgeon
Tampons
Telephone or TV equipment to assist the hard-of-hearing
Therapy equipment
Transportation expenses (relative to health care)
Treatments prescribed by a doctor
Ultraviolet ray treatment
Vaccines
Vasectomy
Wart removal medication
Wheelchair
X-rays
Common medical expenses eligible only with a Doctor's Note
These are some items that we commonly see submitted for reimbursement that require a doctor's Letter of Medical Necessity in order to be reimbursed:
Air conditioner (when necessary for relief from difficulty in breathing)
Cupping
Dietary Supplements
Herbs
Fiber supplements
Massage
Medically necessary cosmetic surgery (breast reduction)
Medicated shampoo & conditioner
Medications often prescribed for weight loss (Semaglutides and Tirzepatides)
Orthopedic shoes
Probiotics
Rolfing
Special school costs for treating disabilities
Vitamins & supplements
Weight loss programs
What expenses are NOT reimbursable through an HRA?
The following expenses are not eligible for reimbursement under QSEHRA or ICHRA:
Advance payment for services scheduled for next year
Airborne/Emergen-C
Athletic club membership
Automobile insurance premiums
Baby Powder
Boarding school fees
Bottled water
Commuting expenses of a disabled person
Cosmetic surgery and procedures
Cosmetics (including face cream and moisturizer)
Cosmetics, hygiene products, and similar items
Cotton Swabs
Dental Floss
Diaper Pail Plastic Bags
Elderberry
Funeral, cremation, or burial expenses
Health programs offered by resort hotels, health clubs, and gyms
Illegal operations and treatments
Illegally procured drugs
Lip balm (including Chapstick and Carmex)
Marriage Counseling (all other mental health counseling eligible)
Maternity clothes
Premiums for life insurance, income protection, disability, loss of limbs/sight, or similar benefits
Premiums for cash benefit indemnity plans
Scientology counseling
Shaving Cream
Social activities
Special foods and beverages
Specially designed car for the handicapped other than an autoette or special equipment
Stop-smoking programs
Tanning lotion
Swimming pool
Toiletries
Toothpaste
Travel for general health improvement
Tuition and expenses for school where availability of medical care isn't the reason for attending
Weight-loss drugs for general wellness
Even if an item feels “health-related,” it is not reimbursable unless it meets IRS medical care requirements and your plan allows it.
For a searchable reference, see IRS Publication 502 for the complete IRS medical expense list.
When do I need a Letter of Medical Necessity (LMN)?
Some expenses are only reimbursable if your doctor provides a Letter of Medical Necessity.
These commonly include:
Vitamins or supplements prescribed for a condition
Weight loss programs (medical necessity only)
Massage therapy prescribed for treatment
Certain medical equipment or special items not normally covered
To be reimbursed:
Obtain a Letter of Medical Necessity from your provider
Upload it with your receipt when submitting the claim
Ensure the documentation clearly explains the medical condition being treated
Are medical expenses reimbursable if I paid them before joining the HRA?
No.
You can only be reimbursed for expenses incurred after your HRA effective start date.
Expenses before your eligibility date are not eligible
The service date (not payment date) determines eligibility
Coverage must be active at the time the expense is incurred
Can my HRA reimburse insurance premiums?
Yes, if allowed by your employer’s plan.
Eligible premiums may include:
Individual health insurance plans (ACA-compliant)
Medicare premiums
COBRA coverage
Some spouse’s employer plan premiums (portion not already pre-tax or employer-paid)
Your reimbursement must follow IRS rules and your employer’s plan design.
How do I know if an expense is eligible?
Follow these steps:
Check if the expense is medical in nature (diagnosis, treatment, prevention)
Confirm it is not excluded by your employer’s HRA plan
Verify it was incurred while your coverage was active
Ensure you have valid documentation (receipt, EOB, or invoice)
Submit the claim through your Take Command portal
If you are unsure, submit the expense for review—eligibility is determined during claim processing.
Why was my reimbursement denied?
Common reasons include:
Expense is not considered medical care under IRS rules
Missing or incomplete documentation
Expense occurred before your HRA start date
Item requires a Letter of Medical Necessity but none was provided
Expense is excluded by your employer’s plan design
You can resubmit with corrected documentation if the issue is fixable.
Do all HRAs cover the same expenses?
No.
Every employer’s HRA plan can customize what is reimbursable.
Some plans only reimburse insurance premiums
Others reimburse a broad range of out-of-pocket medical expenses
Employers define final eligibility rules in the plan document
Always defer to your specific plan design if there is a difference.
What if I’m not sure whether something is eligible?
If you’re unsure:
Submit the expense for review through your portal
Include all supporting documentation
The Take Command team will determine eligibility based on IRS rules and your employer’s plan
You do not need to pre-verify every expense before submitting.
Common questions about eligible expenses
My claim was denied but I believe the expense should be eligible — what should I do?
Before resubmitting, check:
The denial reason shown in the Reimbursements section of your portal or in the email notification.
Whether the expense requires a Letter of Medical Necessity (LMN) — see the list above. If so, obtain an LMN from your provider, combine it with the receipt into a single PDF, and resubmit.
Whether the submitted amount exactly matches the amount on your documentation — mismatches between the submitted amount and what appears on the receipt are a common denial reason.
Whether the service date (not the billing date) falls within your HRA eligibility period.
If you have addressed these and the claim is still being denied, contact Customer Experience with your claim ID or submission date and a description of what documentation you submitted.
My Letter of Medical Necessity was rejected again — why?
Common reasons an LMN is rejected even after resubmission:
The LMN date is after the purchase date — the LMN must be dated on or before the date of service.
The LMN is from a prior plan year — most LMNs are valid for one plan year and must be renewed each year for the same ongoing condition.
The LMN and receipt were not combined into a single PDF file before upload.
The LMN does not document the specific medical condition and clinical rationale — a note simply saying 'medically necessary' is not sufficient.
If you have corrected all of the above and the claim is still rejected, contact Customer Experience before submitting again. Include your claim ID and a description of what has been tried — repeated submissions without resolving the root cause can slow processing.
Does my QSEHRA or ICHRA cover dental and vision expenses?
Dental and vision expenses are generally eligible under IRS rules, subject to your employer's specific plan design:
Dental: cleanings, fillings, extractions, orthodontics, oral surgery, and dental X-rays are generally covered.
Vision: eye exams, prescription glasses, contact lenses, and LASIK surgery are generally covered.
Dental and vision insurance premiums: eligible if your employer's plan includes premium reimbursement and the premiums are for separately purchased dental/vision plans.
Check your HRA Employee Packet (available in your Member Portal) to confirm which expense categories your specific plan covers.