Difference Between Eligible and Dual-Purpose Products

Difference Between Eligible and Dual-Purpose Products

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It is often hard to distinguish what is eligible and what is not. Dual-purpose items are not eligible. So you’re thinking, but what about that allergy-friendly pillow serves a medical purpose, does that count? Or, adult diapers are eligible, what about baby diapers? These two lists below will help answer those questions.

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According to IIAS (Inventory Information Approval System) guidelines:

Eligible Products

Eligible OTC: Eligible products include OTC products that are for medical care and are primarily for a medical purpose. They include products (other than OTC medicines or drugs) that diagnose, alleviate or treat existing or imminent injuries, illnesses or medical conditions. As a general rule, most of these products are of short-term use but some do treat chronic medical conditions. Qualified medical expenses include those over-the-counter items compliant with federal tax rules under IRS Code Section 213(d) as outlined by the Internal Revenue Service. In these cases, the expense would not have been paid “but for” the disease or illness. An expense is not deductible as medical care if the taxpayer would have paid the expense even in absence of a medical condition. The user does not need to provide a statement from a medical provider or indicate a diagnosis in order to receive reimbursement.  Taxes, shipping and surcharge / convenience fees (as permitted by law and card brand / network regulations) directly associated with the purchase of an eligible product can be included.

Prescribed Drugs and Medicines, including Prescribed OTC: Drugs and medicines prescribed by a licensed medical professional and dispensed in accordance with state laws including the generation of an Rx Number are considered Eligible by the IRS.  This includes OTC Drugs and Medicines other than dual-purpose.  Since the prescription serves as determination of medical eligibility in a merchant location with a properly configured Pharmacy and IIAS POS System, no additional checks are required.  These items will not be listed on the Eligible Products list due to their separate processing rules.

 

Not Included as Eligible Products

All OTC Medicines and Drugs without a Prescription: OTC drugs and medicines can only be reimbursed with a valid physicians’ prescription.  FSA and HRA debit cards can be used only if the OTC drug or medicine is filled by the pharmacist and an Rx number has been assigned.  As such, they have been removed from the Eligible Products List as the list only covers items where a prescription is not required by IRS regulations.

Dual-purpose: Some products are considered dual-purpose. These products may have both a medical purpose and a personal hygiene, cosmetic or general health purpose. In order to be considered eligible, they must be used to treat a medical condition and cannot be used to improve or maintain general health unless prescribed by a physician to treat a specific illness, condition or injury. These products may be eligible for reimbursement, but require a letter of medical necessity from a licensed healthcare professional stating the specific diagnosis or medical condition, the specific OTC medicine recommendation to treat the condition, and documentation of the product and cost. Dual-purpose items will not be included in the SIGIS List.

Ineligible: Products that are used for general health, cosmetic, or personal hygiene purposes are not reimbursable. Typically, these are not referred to as medicines or drugs and are not recognized to treat a medical condition. Expenses that are not reimbursable under IRS Code Section 213(d) of the federal tax code are ineligible. These include food supplements, toiletries, lotions and soaps, shampoos, vitamins and most herbal supplements.

The following are types of products that typically would be included under each designation.

*These are strictly guidelines and do not represent an all-inclusive listing. (As of 11/1/2015)

 

Eligible:

Category Example Comment
Acupressure Treatments Sea Band, Flents EZ Travel Wrist Band Products that treat a medical condition are eligible. Weight-loss products are dual-purpose.
Breast Pumps and Breast-Feeding Supplies Breast Pump (cost or rental fee), Breast Pump Parts (pump valve, replacement tubing, piston unit, diaphragms, pump body, flange, shield), Storage Bottles, Storage Bags, Gel Pads, Nursing Pads, Nipple Shields, Conversion Kits, Areola Stimulator, Car Adapter Products that directly aid lactation are eligible. Items not eligible include: Bottle Stands, Bottle Nipples, Cleaners, Freezer Blocks, Bra Shields and Nursing Pillow and Covers, Nursing Bras and Milk Coolers
Compression Hosiery Medical Compression 30-40 and above; Any compression of Anti-Embolism Stockings, Ulcer Care Compression or Lymphedema Treats condition-specific medical conditions such as anti-embolism, ulcer care or lymphedema
Contraceptives Condoms (with and without spermicide) – Trojan, Durex, Lifestyle. Excludes drugs and medicines which require a prescription (ie. birth control pills) Spermicide-only products are not eligible.
Cotton Balls, Rolled Cotton, Cotton Applicators US Cotton Sterile Cotton Balls and Rolls Only Sterile cotton products are eligible. Non-sterile products are dual-purpose.
Dental Repair Dentek, Temparin, DOC Recapit Temporary dental repair products are eligible.
Denture Adhesives, Repair,  and Cleansers PoliGrip, Benzodent, Plate Weld, Efferdent Denture cleaners and maintenance products are eligible. Medicated pain relief is not eligible.
Diabetes Care Ascensia Meters & Strips, One Touch Meters & Strips, Softclix Lancets & Device,  Monoject insulin syringes; Dex 4 glucose products Testing (meters, strips, lancets, alcohol swabs), dosing (syringes, pens, etc.), glucose are eligible. OTC medicines and personal care are ineligible or dual purpose.
Diagnostic Products (Includes thermometers, blood pressure monitors, cholesterol testing, pulse oximeters) Braun Forehead Thermometer, Nexcare Thermometer, Lifescan BP Monitor, Cholestrak, Azo UTI Test Strips, Quest Pulse Oximeter Includes devices that monitor, screen or test for the presence of disease, dysfunction of the body or for other medical conditions; drug, alcohol and body fat testers are dual-purpose.
Diapers – Juvenile Incontinence GoodNites, Under Jams Products marketed for juvenile incontinence only. Regular diapers and training paints are not eligible.
Durable Medical Equipment Wheel Chairs, Crutches, Oxygen Machines Can be included when manufacturer provides UPC, merchants can mark non-UPC tagged items as private label items. See Home Health Care for additional criteria.
Ear Care Sweet oil, Bionix Oto Clear, Select Nutrition Ear Wax Candle, Provent Hearing Aid Dryer Un-medicated ear drops (sweet oil) ear syringes, ear wax removal devices, ear candles, hearing aid cleaners and dryers.
Enemas Bags, Syringes, prefilled saline enemas – Fleet Devices are eligible. Prefilled saline-only enemas are eligible.
Eye Care Contact lens care, eyeglass repair kits Products used to maintain corrective lenses and frames are eligible. Post-surgical eye protection is eligible.
Family Planning EPT, Answer Quick & Simple Ovulation Test, ClearBlue Fertility Monitor Pregnancy, ovulation and fertility kits are eligible. Dietary supplement-only products are not eligible.
First Aid Dressings & Supplies Band Aid, 3M Nexcare, J&J First Aid, non-sport tapes, Simply Saline Wound Wash. Saline wound washes are eligible. Bandages impregnated or coated with a medicated product are eligible. Tapes and bandages indicated as “Athletic” or “Sport” are not eligible.
Foot Care Treatment Un-medicated corn & callus cushions & pads, corn & callus remover implements; therapeutic insoles, orthotic inserts, arch supports, heel cups Products that have a primary purpose to treat specific ailments are eligible; products for general use or comfort are dual-purpose.
Glucosamine &/or Chondroitin Osteo-Bi-Flex, Cosamin D, Flex-a-min Nutritional Supplements Glucosamine-only or main ingredient glucosamine products are eligible.
Head Lice Products Nix Lice Comb, Rid Lice Comb Combs, electronic devices are eligible. Preparations are not eligible.
Health Care Services Urgent Care or Primary Care services provided by a licensed practitioner at an IIAS merchant
Health Supports ACE, Futuro, braces, elastic bandages, hot/cold therapy, orthopedic supports, rib belts, back braces, etc. Waist shapers, tummy supports, work-related, athletic/sports products are dual-purpose.
Hearing Aid/Medical Batteries Duracell, Energizer Hearing Aid Batteries Multi-purpose batteries not eligible
Home Health Care (limited segments) Elevated toilets, commodes, limb/joint protectors, medical/nutritional IV products, urinals/bedpans, traction, specialized braces & supports, ostomy, mastectomy products, urological, respiratory (excluding general air filters), electrotherapy, mobility (canes, walkers, rollators, wheelchairs), wound care, incontinence, diagnostics (stethoscopes, thermometers, bp monitors), medication dosers/organizers and medical alerts (jewelry, alarms, etc.) are eligible. Bathroom safety, nutritional foods/liquids, positioning & support (backrests, pillows, etc.), patient room supplies, physical therapy, aids for daily living,  drug & alcohol tests are dual-purpose. General rule applies that these products may be used as part of the aging process which is not considered a medical condition. Accessories not related to the actual function of equipment, such as cup holders, totes and baskets, are dual-purpose. See Dual-Purpose Home Health Care section.
Hot & Cold Therapy ACE Hot/Cold Compress, Cara Ice Bag, Bed Buddy Back Wrap, Kaz Heating Pad, ThermaCare Heat Wrap Freezer or instant cold packs, microwave or instant hot packs/pads, ice bags and electric heating pads are eligible. Medicated pads are not eligible.
Incontinence Protection Attends, Depend, Prevail, GoodNites, UnderJams Skin care, cleansing products and diapers/training pants are dual-purpose.
Lip Balms – Sun Care Banana Boat SPF 50, Bullfrog Water Armor SPF30 Lip balms which are part of a sun care line and have an SPF15+ and state UVA/UVB are eligible. General moisturizers with SPF are dual-purpose.
Mouth Guards Dentek, Night Guard Night mouth guards are eligible. Sports guards are not eligible.
Nasal Moisturizers & Washes Neilmed Neti Pot & solutions, Ocean Saline Spray, Simply Saline Products that are saline and primarily for moisturizing but may contain added aloe, menthol or eucalyptus, etc. are eligible. Decongestants & homeopathics are not eligible.
Prenatal Vitamins Stuart Prenatal, Nature’s Bounty Prenatal Vitamins
Reading glasses and maintenance accessories Foster Grant Reading Glasses, Apex Eye Glass Repair Kit, BL Sight Saver Lens Cloths Accessories used to maintain corrective lenses and frames are eligible. Chains, cases, etc. are not  eligible.
Sun Protection (SPF 15 & above) and “Broad Spectrum”) Coppertone SPF15+, Banana Boat SPF 15+, Cerave SPF 30, No-Add Sport Stick SPF50 Primary use must be for protection against skin cancer and premature skin aging with indication of UVA and UVB protection (broad spectrum) and 15 and above (15+). Products that are primarily moisturizers/cosmetic with a sun screen are dual-purpose.
TENS Homedics Rapid+Relief, Icy Hot Smart Relief, Zewa Spa Buddy TENS units and supplies are eligible.
Wart Removers – Cryo Products Compound  W Freeze Off, Dr Scholl’s Freeze Away, Wartner Only non-medicated, freeze-method products are eligible.
Vaccinations Flu Shots, Pneumonia Vaccinations

 

Dual-purpose (Not Included in Eligible Product List):

Personal care and treatments are not eligible.

Category Example Reimbursement Use
Allergy Pillows, Mattress Covers, Air Purifiers, Filters, etc. Allerease Pillow Cover, Allergy Control Bedding, Honeywell HEPA Allergan Remover Air Purifier To treat allergies diagnosed by physician
Anti-bacterial Hand Sanitizers Purell, Nexcare, Germ-X Personal use component; but/for test must be established
Baby Diapers Huggies, Pampers, Pullups To treat juvenile incontinence or medical condition
Baby Formulas/Nutritionals Pediasure, Progestimi, Enfamil RTFl Only specialty formulas/nutritionals are covered if medically necessary and authorized by medical practitioner. Only the excess cost between regular formula and the specialized formula may be eligible under an employer’s plan.
Compression Hosiery and Accessories Jobst, TED, Futuro – 20-30 or below, garters, care kits, fixatives, etc. Most of these products primary purpose is for general health or mild medical treatments at compressions 20-30 or below. They are dual-purpose/ineligible but may be reimbursed for the cost over “regular” socks/hosiery if a LOMN is submitted.
Cough, Cold & Flu dietary supplements Airborne, Hall’s Defense, Germ Defense Alka Seltzer Immunity Products that are merely dietary supplements and marketed as such, including those claiming to “support the immune system” (i.e. Airborne), are not covered (dual-purpose). Cold preventative products which are “proven to lessen the severity” or “reduce the duration” of colds or flu are covered. These include homeopathic, natural products, some herbals and some forms of zinc.
Diabetes Nutritionals Glucerna, Boost Glucose To treat symptoms of diabetes when recommended by physician
Diabetes Personal Care & Supplies (includes diabetes skin care, cough & cold and socks) Diabet-X Therapeutic Body Lotion, Diaderm Foot Cream, Diabetic Tussin, Dr. Comfort Diabetes Socks, Jobst Sensifit Socks Personal care is generally not covered; must test or treat a specific symptom or condition of Diabetes.  Diabetes socks are dual-purpose/ineligible but may be reimbursed for the cost over “regular” socks/hosiery if a LOMN is submitted.
Dietary Supplements All dietary supplements including multiple vitamins, minerals, essential fatty acids (fish oil), oy, enzymes, amino acids, etc. Dietary supplements, including herbals & botanicals are dual-purpose (exception: glucosamine & prenatal vitamins).
Drug & Alcohol Testing Kits First Check Drug Testing, Alcohawk Breathalyzer Diagnostics of illegal activities are not eligible
Ear plugs Mack’s, Flents To treat medical condition (presence of middle/inner ear tubes) diagnosed by physician
Exercise Equipment Treadmill, exercise bike, pedalers, weights, hand exercisers Exercise equipment is dual purpose in support of general health or a medical condition
Face/Respiratory Masks – medical grade or commercial/consumer 3M Cold weather, pollen/dust filtering masks Products used for, cold weather, dust/pollen may also be used for work/general health needs.
Feminine Moisturizing Replens, Rephresh To treat vaginal dryness caused by medical condition
Feminine Protection (Pads & Liners) Kotex, Always, Stayfree They are ordinarily considered as being used to maintain general health and for personal care. They are dual-purpose if used for post-surgery or child birth
First Aid Burn & Scar Treatments & Skin Protectants (petroleum jelly) Aloe, Mederma, Neosporin Scar Solution, Vaseline Jelly Most are cosmetic in nature or have general use purposes
Fluoride Treatments Gel-Kam To treat medical condition diagnosed by physician & not for general oral care
Food Thickeners Thick-It Personal use component; but/for test must be established
Foot Insoles and Cushioning Insoles, Heel & Arch, Dr. Scholl’s Air Pillo, Odor Eaters General use or comfort products are dual-purpose. Products must treat specific ailment to be eligible.
Gloves (Rubber & Cotton) Cara Cotton Gloves, Curad Vinyl Gloves, Tronex Latex Gloves Protective gloves of any type & cotton beauty gloves are dual-purpose.
Hair Growth Products Rogaine To treat symptom of medical condition diagnosed by physician
Health Supports – Athletic, Sports or Work Related ACE Work Belt, Curad Sports Tape Any products with a primary purpose of sports or work/industrial are dual-purpose.
Herbals & Botanicals Echinacea, ginkgo biloba, garlic Dietary supplements, including herbals & botanicals are dual-purpose (exception: glucosamine & prenatal vitamins).
Home Health Care (limited segments) Including but not limited to: Bathroom safety, nutritional foods/liquids, positioning & support (backrests, pillows, etc.), patient room supplies, physical therapy, aids for daily living, drug & alcohol tests. General rule applies that these products may be used as part of the aging process which is not considered a medical condition. Accessories not related to the actual function of equipment, such as cup holders, totes and baskets, are dual-purpose. Home Health Care is dual-purpose other than what is indicated in the Home Health Care eligibility section.
Incontinence Personal Care (Including perineal cleansers, moisturizers and general skin protectants) Aloe Vesta 2n1, Ca-Rezz Wash, Sween Cream Personal care and treatments are not eligible
Lip Balms – Moisturizers Aquaphor SPF, Dermatone SPF23 Those with a primary purpose of moisturizing but have an SPF of 15+ and state UVA/UVB. (Lip balms with sunscreen that are part of a sun care line are eligible)
Magnifying Glasses BL Sight Saver Magnifying Glass, Flents Wallet Size Magnifying Glass
Medical Nutritionals Resource, Peptamen, Nutren Satisfies normal nutritional needs and does not treat a specific condition
Medicated & Specialty Soaps Basis Bar, Cetaphil Cleansing Bar To treat skin condition diagnosed by physician
Minerals Calcium Carbonate, Ferrous Sulfate, etc. Under narrow circumstances, they will be eligible if used to treat medical condition or at-risk for illness diagnosed by physician
Nasal Strips & Snore Relief Breathe Right To treat sleep apnea or improper breathing diagnosed by physician
Nutritional Foods Ensure, Boost To treat medical condition diagnosed by physician & not for general health
Probiotics and Prebiotics Culturelle, Florastor To treat digestive condition and recommended by physician & not for general digestive health
Skin Care – Therapeutic Hand & Body Eucerin, Aquaphor, Amlactin To treat or remedy a skin condition diagnosed by physician. Lotions with SPF are primarily used as moisturizers and are dual-purpose.
Therapeutic Shampoo & Scalp Treatments (Medicated) Nizoral, Neutrogena T-Gel To treat skin/scalp condition for short duration diagnosed by physician
Vaporizers & Humidifiers and Accessories Vicks, Sunbeam, Kaz Covered if used to treat illness; not covered for normal household use
Vitamins Vitamin A, C, D, E, multivitamin, lutein eye vitamin Under narrow circumstances, they will be eligible if used to treat medical condition or at-risk for illness diagnosed by physician
Weight Control Supplements Alli, Slim Fast To treat obesity diagnosed by physician

 


 

Source: https://sig-is.org/about-sigis