Eligible: Devices and Supplies 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- Breast Pump (cost or rental fee), Breast Products that directly aid lactation Feeding Supplies Pump Parts (pump valve, replacement are eligible. tubing, piston unit, diaphragms, pump body, flange, shield), Storage Bottles, Storage Items not eligible include: Bottle Bags, Gel Pads, Nursing Pads, Nipple Stands, Bottle Nipples, Cleaners, Shields, Conversion Kits, Areola Stimulator, Freezer Blocks, Bra Shields and Car Adapter Nursing Pillow and Covers, Nursing Bras and Milk Coolers. Compression Hosiery Medical Compression 30-40 and above; any Treats condition-specific medical compression of Anti-Embolism Stockings, conditions such as anti-embolism, Ulcer Care Compression or Lymphedema ulcer care or lymphedema. Contraceptives (with and without spermicide) – See also Contraceptives under , Durex, Lifestyle OTC Drugs and Medicines for products that include an active drug ingredient. Cotton Balls, Rolled Cotton, US Cotton Sterile Cotton Balls and Rolls Only Sterile cotton products are Cotton Applicators eligible. Non-sterile products are dual-purpose. Dental Repair Dentek, Temparin, DOC Recapit Temporary dental repair products are eligible. Denture Adhesives, Repair, PoliGrip, Benzodent, Plate Weld, Efferdent Denture cleaners and and Cleansers maintenance products are eligible. See also Denture Pain Relief under OTC Drugs and Medicines for products that include an active drug ingredient. Diabetes Care Ascensia Meters & Strips, One Touch Testing (meters, strips, lancets, Meters & Strips, Softclix Lancets & Device, alcohol swabs), dosing (syringes, Monoject insulin syringes; Dex 4 glucose pens, etc.), glucose are eligible. products Personal Care are ineligible or dual purpose. Diagnostic Products Braun Forehead Thermometer, Nexcare Includes devices that monitor, (Includes thermometers, Thermometer, Lifescan BP Monitor, screen or test for the presence of blood pressure monitors, Cholestrak, Azo UTI Test Strips, Quest disease, dysfunction of the body cholesterol testing, pulse Pulse Oximeter or for other medical conditions. oximeters, drug, alcohol and body fat testers) Diapers – Juvenile GoodNites, Under Jams Products marketed for juvenile Incontinence incontinence only. Regular diapers and training paints are not eligible.

Downloada ble Apps with App cost could be a med ical Medical Functions for expense if used for medical tablets and smartphones purpose only (i.e. track heart rhythm). Apps that include function for general wellness are not eligible. Du rable Medical Equipment Wheel Ch airs , Crut che s, Oxygen Ma chines Can be included wh en manufacturer provides UPC, merchants can mark non-UPC tagged items as private label items. See Home Health Care for additional criteria. Ear Ca re Bi onix Oto Clea r, Select Nutrition Ear Wax Ear drops ear syringes, ear wax Candle, Provent Hearing Aid Dryer removal devices, ear candles, hearing aid cleaners and dryers. See also Ear Care under OTC Medicines and Drugs for products that include an active drug ingredient. Ene mas Bag s, Syringes, prefilled sali ne ene mas - De vices are eligible. Prefil led Fleet enemas are eligible. Eye Ca re Conta ct lens care, eyeglass repa ir kits Produ cts used to mainta in corrective lenses and frames are eligible. Post-surgical eye protection is eligible. Family Planning EP T, Answer Quick & Si mple Ovulat ion Pregnancy, ovulation and fertility Test, Clearblue Fertility Monitor kits are eligible. Dietary supplement only products are not eligible. Firs t Aid Dress ings & Band Aid, 3M Ne xc are, J&J Firs t Aid, non - If the main pu rpo se is for med ical Supplies sport tapes, Simply Saline Wound Wash care, and there is no “normal” use that is not medical, it could automatically qualify as eligible. Saline wound washes are eligible. Bandages impregnated or coated with a medicated product are eligible. Tapes and bandages indicated as "Athletic" or "Sport" are eligible unless marketed as performance enhancing. Foot Ca re Treat men ts Co rn & callus cushions & pad s, corn & Produ cts that have a primary callus remover implements; therapeutic purpose to treat specific ailments insoles, orthotic inserts, arch supports, heel are eligible; products for general cups use or comfort are dual-purpose. Glucosamine &/or Os teo -Bi -Fl ex, Co samin D, Flex-a-min Glucosamine-only or main Chondroitin Nutritional Supplements ingredient glucosamine products are eligible. Head Lice Products Nix Lice Co mb, Rid Lice Comb Co mbs, electron ic devices are eligible. Preparations are not eligible. Hea lth Care Serv ices Urgent Care or Primary Ca re servi ces provided by a licensed practitioner at an IIAS merchant

Hea lth Suppo rts ACE, Futu ro, braces, elastic ban dage s, If the main pu rpo se is for med ical hot/cold therapy, orthopedic supports, rib care, and there is no “normal” use belts, back braces, etc. that is not medical, it could automatically qualify as eligible. Athletic tape – typically used on existing injuries or as prevention against further injury, similar to a brace or wrap; not a performance enhancement product will be eligible. Work/industrial back braces belts used to prevent or treat back injury will be eligible. Items eligible if not marketed solely for performance enhancements. Hea ri ng Ai d/M edical Du racell, Ene rgizer Hearing Aid Bat teries Mu lti-pu rpo se batte ries not Batteries eligible. Home Health Care (limited Elevated toilets, commodes, limb/joint Bathroom safety, nutritional segments) protectors, medical/nutritional IV products, foods/liquids, positioning & shower grab bar, bath transfer benches, support (backrests, pillows, etc.), shower stools, urinals/bedpans, traction, patient room supplies, physical specialized braces & supports, ostomy, therapy, aids for daily living. mastectomy products, urological, respiratory General rule applies that these (excluding general air filters), products may be used as part of electrotherapy, mobility (canes, walkers, the aging process which is not rollators, wheelchairs), wound care, considered a medical condition; incontinence, diagnostics (stethoscopes, however equipment that assists thermometers, blood pressure monitors, daily functions like mobility qualify drug and alcohol tests), medication even if impairment is due to dosers/organizers and medical alerts aging. Accessories not related to (jewelry, alarms, etc.) are eligible the actual function of equipment, such as cup holders, totes and baskets, are dual-purpose.

See Dual-Purpose Home Health Care section. Hot & C old The rapy ACE Hot /Co ld Co mpress , Ca ra Ice Bag, Fr eezer or instant cold pa cks , Bed Buddy Back Wrap, Kaz Heating Pad, microwave or instant hot ThermaCare Heat Wrap packs/pads, ice bags and electric heating pads are eligible. See also Pain Relief Oral and Topical for Medicated pads. In con tinence Prote ction Att end s, Depend, Prevail, Good Nite s, Skin care, clean sing products and UnderJams diapers/training pants are dual- purpose. Lip Balms – Sun Care Banana Boat SP F 50, Bull frog Water Armor Primary use must be for SPF30 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 sunscreen are dual-purpose.

Men strual Care Produ cts: Kote x, Always, Sta yfree, Tampax Expen ses ass oci at ed with Feminine Protection menstruation or other genital-tract secretions. (Tampon, Pads, Liner, Cup, Sponge, Disposable or Non-disposable Underwear for Menstruation, or other similar products). Mou th Gua rds Dente k, Night Guard Night mouth guards are eligible. Mouth guards used in sports to prevent mouth injury and reduce the risks of concussions will be eligible if not marketed solely for performance enhancements. Na sal Moistu ri zers & Ne ilmed Neti Pot & solutions, Oc ean Saline Produ cts that are saline and Washes Spray, Simply Saline primarily for moisturizing but may contain added aloe, menthol or eucalyptus, etc. are eligible. Na sal Stri ps & Sno re Relief Brea the Right To treat sleep apnea or improper breathing. Excludes strips marketed solely for performance enhancements. Pren atal Vita mins Stua rt Prenat al, Natu re's Boun ty Pren atal Vitamins Rea ding Glass es and Foster Gr ant Reading Glasses, Apex Eye Acc ess ories used to maint ain Maintenance Accessories Glass Repair Kit, BL Sight Saver Lens corrective lenses and frames are Cloths eligible. Chains, cases, etc. are not eligible. Sun Protection (SPF 15 & Cop perto ne SPF15+, Banana Boat SPF Primary use must be for above and Broad 15+, Cerave SPF 30, No-Add Sport Stick protection against skin cancer Spectrum”) SPF50 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 Ho med ics Rap id+Relief, Icy Hot Smart TENS units and supplies are Relief, Zewa Spa Buddy eligible. Wart Removers – Cryo Co mpound W Freeze Off , Dr Scholl’s Products Freeze Away, Wartner Vacc inations Flu Shot s, Pneu mon ia, Shing les Vaccinations

OTC Medicines and Drugs (Included in Eligible Product List): Tabl e Ca tego ry Exam pl e Comme nt Acid Cont rollers Pep ci d AC, Zanta c, Pri losec Acne Me dicat ions Clea rasil , OXY Allergy & Sinus Al avert, Ben adryl, Claritin, Sudafed Antibiot ic Products Bacitracin, Neo spo rin, triple an tibiot ic ointment Anti-Diarr heal Imod ium, Kaope cta te Anti-Gas Gas-X, Phazyme Dietary Supplement gas products/enzymes are dual- purpose.

Antifung al (F oot) La misil , Lotrimin Anti-It ch & In sect Bi te Ca ladryl, Lana cane, Sarna, hydrocortisone Remedies Antipa rasitic Treat ments Nix, Rid, li ce treat ments Antisep tics & wound Rub bing alcohol, peroxide, Ep som salt, cleansers Betadine, Hibiclens Baby Electrolytes and Pedialyte, Enfalyte Baby Electrolytes and dehydration dehydration. Baby Rash Ointments & De sitin, Avee no Baby Includes petroleum jelly Creams merchandised and marketed for baby rash. Baby Teet hing Pain Baby Or ajel, Anbe sol Baby Or al Gel Co ld Sore Re med ies Abreva, He rpe cin, Or ajel Only med icated produ cts are covered. Cont racept ives (non- Encare Inserts, VCF Fil m, Pl an B Tab let OTC drugs or med icated products) spermicide-only products are eligible. See Contraceptives under Devices and Supplies for non-medicated product eligibility. Cou gh, Cold & Flu Rob itu ss in, The raflu, Vicks, Ha lls, Cepa col, Co ld preventa tive produ cts wh ich Zicam, Cold-Eeze, Diabetic Tussin 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. Products that are merely dietary supplements and marketed as such, including those claiming to "support the immune system" (i.e. Airborne) are not covered. Hand sanitizers not covered. Dentu re Pain Relief Or ajel De ntu re Pain Relief Gel, Benzode nt Cream Dige stive Ai ds La cta id, Lacta se, Beano Dige stive aids that are Dietary Supplements are dual purpose. Ear Ca re Me dicat ed ear d rop s, Deb rox, Si mil asi n Eye Ca re Vi si ne, Refresh Tea rs Feminine Antifung al and Mo nistat, Gyne -Lot rimin, Vag isi l, Soot hing Anti-itch Care Fiber Laxatives (bulk Benefiber, Fibercon, Metamucil (powder or Covered when used to treat a forming) pills) medical condition for short duration; bars and drinks that are "nutritional foods" for help with regularity are not covered (dual- purpose). Firs t Aid Burn Re med ies De rmop last, Solarc aine Mu st con tain an an tisep tic or pa in reliever, 100% aloe is not covered (dual-purpose). Foot Ca re Treat ment Co rn & callus treatment s, wa rt removers Produ cts that treat spe cific ailments are eligible; products for general use or comfort are not eligible (dual-purpose). He morr ho id Prepa rations Prepa ration H, Tucks

Ho meopath ic Remed ies Boiron and Hyland produ cts Ho meopath ic produ cts are classified as drugs under the Food, Drug & Cosmetic Act and fall under the same criteria as other OTC Medicines. In con tinence Prote ction & Ca lmosept ine, Ba za Anti-fung al Cream Skin and cleansing produ cts not Treatment Products covered (dual-purpose). (Includes anti-fungal) La xat ives (non -fibe r) Du lcolax, Ex-La x, Miralax Stimulan t, saline, lub ricant, et c. (non-fiber). Mot ion Si ckne ss Dramamine, Bonine Acup ress ure produ cts are eligible. Me dicat ed Na sal Sprays, Afrin Spray Drops & Inhalers Me dicat ed Na sal Strips Or al Re med ies or Sali vart, Anbesol, Or ajel, Dente mp Only dry mouth remedies that are Treatments (Includes Saliva saliva substitutes are covered substitutes, mouth sore (gels, sprays, etc. not treatments, dental repair) mouthwash, rinses, toothpaste). Pain Relief Or al & Top ical Tylenol, Advil, Midol, Bayer Aspirin, Me dicat ed topical pain relieve rs Aspercreme, Ben-Gay, Icy Hot that contain menthol, eucalyptus, capsaicin, trolamine salicylate, etc. are not covered. Air- activated heat patches are covered. Me dicat ed Re spirato ry Primatene, Bron kaid, med ic ated Vi cks In cludes asth ma medi cat ion; Treatments and Vapor Vapor Rub vaporizers and humidifiers are Products dual-purpose. Skin treat ments Psoriasi n, MG21 7, De rmarest Eczema Me dical expen se as long as intended purpose is to treat existing skin conditions like eczema, psoriasis, rosacea, etc. (as opposed to mere prevention). Sl eep Aids & Seda tives Un isom, Nytol, Sominex Smoking Dete rr ents Nicode rm, Nicorette Sto mach Re med ies Mylan ta, Ma alox, Tums

Dual-purpose (Not Included in Eligible Product List): Ca tego ry Exam pl e Re imbu rseme nt Use Allergy Pill ows, Ma ttress Allerea se Pillow Cover, Allergy Cont rol To treat allergies diagno sed by Covers, Air Purifiers, Bedding, Honeywell HEPA Allergan physician. Filters, etc. Remover Air Purifier Anti-ba cte rial Ha nd Purell , Ne xc are, Germ-X Pers on al use component; but/ for Sanitizers test must be established. Baby Diape rs Hug gies, Pampe rs , Pullups To treat juvenile incon tinence or medical condition. Baby Formulas/Nut rition als Pediasure, Proge stimi, RTFl Only spe cialty 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.

Co mpress ion Ho siery and Job st, TED, Futu ro – 20-30 or below, Mo st of the se products pri mary Accessories garters, care kits, fixatives, etc. 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. Co smet ics /Beau ty Produ cts Co lorsc ience Po wders & Mou ss e, Bare The primary pu rpo se of t he se with Sunscreen Minerals Powders, Neutrogena Healthy products is not sun protection and Skin Glow Sheers would not pass the “but for” test. The manufacturer’s identity is cosmetic; product is marketed as cosmetic in nature (improves or enhances appearance, tints/colors) and usually found in cosmetic departments or outlets. Cou gh, Cold & Flu Dietary Ai rborne, Ha ll's De fen se, Germ Defen se Produ cts that are merely dieta ry Supplements Alka-Seltzer Immunity 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 Nut ritionals Glucerna, Boost Glucose To treat sympto ms of d iab etes when recommended by physician. Diabetes Personal Care & Diabet -X The rapeu tic Body Lo tion, Diade rm Personal care is generally not Supplies (includes diabetes Foot Cream, Dr. Comfort Diabetes Socks, covered; must test or treat a skin care and socks) Jobst Sensifit Socks 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 dieta ry supplements incl ud ing multiple Dietary supp lement s, including vitamins, minerals, essential fatty acids (fish herbals & botanicals are dual- oil), oy, enzymes, amino acids, etc. purpose (exception: glucosamine & prenatal vitamins). Ear plugs Ma ck's, Flents To treat med ical con dition (presence of middle/inner ear tubes) diagnosed by physician. Exerc ise Equipment Trea dmill , exerc ise bike, peda lers , we ight s, Exerc ise equipment is du al hand exercisers purpose in support of general health or a medical condition. Face/Re spirato ry Ma sks - 3M Cold we athe r, po llen/ du st fil te ring Produ cts used for, cold weathe r, medical grade or masks dust/pollen may also be used for commercial/consumer work/general health needs. Feminine Moistu rizi ng Rep len s, Reph resh To treat vaginal dryness caused by medical condition.

Firs t Aid Burn & Scar Al oe, Me derma, Neo spo rin Scar Solution, Mo st are cosmet ic in na ture or Treatments & Skin Vaseline Jelly have general use purposes. Protectants (petroleum jelly) Fluo ri de Treat ments Gel-Kam To treat medical condition diagnosed by physician & not for general oral care. Food Thickene rs Thic k-It Pers on al use component; but/ for test must be established. Foot In soles and In soles, He el & Arc h, Dr. Scho ll 's Ai r Pillo, Gene ral use or comf ort produ cts Cushioning Odor Eaters are dual-purpose. Products must treat specific ailment to be eligible. Gloves (Ru bber & Cot ton) Cara Cotton Gloves, Curad Vinyl Gloves, Prote ctive gloves of a ny type & Tronex Latex Gloves cotton beauty gloves are dual- purpose. Ha ir Gr owth Produ cts Rog aine To treat symptom of med ic al condition diagnosed by physician. Hea lth Suppo rts – Athletic, Spo rts compress ion sleeve, compress ion Any produ cts with a primary Sports garments, etc. purpose of performance enhancement are dual-purpose. He rbals & Botan icals Echinacea, ginkgo biloba, garli c Dietary supplements, including herbals & botanicals are dual- purpose (exception: glucosamine & prenatal vitamins). Ho me Hea lth Ca re (li mited In cluding but not limited to: Nut ritional Gene ral rule applies that th ese segments) foods/liquids, positioning & support products may be used as part of (backrests, pillows, etc.), patient room the aging process which is not supplies, physical therapy, aids for daily considered a medical condition; living. however, equipment that assists daily functions like mobility qualify even if impairment is due to aging. Accessories not related to the actual function of equipment, such as cup holders, totes and baskets, are dual-purpose. Large expenditures like walk-in bathtub are dual purpose and may fall under capital expenditures. Home Health Care is dual- purpose other than what is indicated in the Home Health Care eligibility section (i.e. some patient room supplies like urinals/commodes and patient lifting and some aides for daily living like med dosers/organizers and medical alerts are eligible exceptions). In con tinence Pers on al Ca re Al oe Vesta 2n1, Ca -Rezz Wash, Sween Pers on al care and treat ments are (Including perineal Cream not eligible. cleansers, moisturizers and general skin protectants)

Inversion Table May be used to treat medical conditions or used for general health. Inversion Tables are considered dual-purpose expenses. Lip Balms - Moisturizers Aquaphor SPF, Dermatone SPF23 Those with a primary purpose of moisturizing but have SPF of 15+ and state UVA/UVB are dual purpose. (Lip balms with sunscreen that are part of a sun care line are eligible). Cosmetics with SPF are not 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 Basis Bar, Cetaphil Cleansing Bar To treat skin condition diagnosed Soaps 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. Nutritional Foods Ensure, Boost To treat medical condition diagnosed by physician & not for general health. Personal Amplification Can be used for enhancing sound Devices for those not hearing impaired for personal benefit and not as a hearing aid. Items are dual- purpose. Probiotics and Prebiotics Culturelle, Florastor To treat digestive condition and recommended by physician & not for general digestive health. Skin Care - Therapeutic Eucerin, Aquaphor, Amlactin To treat or remedy a skin Hand & Body condition diagnosed by physician. Lotions with SPF are primarily used as moisturizers and are dual-purpose. Therapeutic Shampoo & Nizoral, Neutrogena T-Gel To treat skin/scalp condition for Scalp Treatments short duration diagnosed by (Medicated) physician. Vaporizers & Humidifiers Vicks, Sunbeam, Kaz Covered if used to treat illness; and Accessories not covered for normal household use. Vitamins Vitamin A, C, D, E, multi-vitamin, lutein eye Under narrow circumstances, vitamin they will be eligible if used to treat medical condition or at-risk for illness diagnosed by physician. Weight Control Alli, Slim Fast To treat obesity diagnosed by Supplements physician.

Other Ineligible Products

Category Example Comment Baby Toiletries, Baby Oil, Johnson's Baby oil/Powder, Aveeno Baby Powder, Lotions & Creams Lotion Beauty Shampoos, Pantene, Suave, Dove, Aveeno Nourishing Conditioners, Hair Treatment, Clairol Hair Color Treatments & Hair Coloring Cosmetics Revlon, CoverGirl Deodorants Speed Stick, Degree Facial Cleansers Neutrogena Deep Clean, Dove Facial Cleanser Feminine Cleansing Massengill, Summer's Eve Products Foot Grooming (Includes Pedifix Foot File, O’Keefe’s Foot Cream, Non-medicated Implements, beauty & Desenex Foot/Sneaker Spray comfort, moisturizers, odor & wetness) Hair Removal & Bleaches Nair, Hand & Body Cleansing Dove, Dial soap Lip Preparations ChapStick, lip balm Oral Care (Includes Crest, Colgate, Scope, Listerine, Binaca Will not qualify even if a dentist toothpaste, toothbrush, recommends a special product to mouthwash, breath treat a medical condition like remedies) gingivitis. These are primarily used to maintain general health. Shaving & Men's Grooming Gillette, Schick Skin Care (Includes Aquaphor Ointment, Cococare Lotion, Dr moisturizers, hand & body, Teal Bath Salt bath products) Sport Energy Liquids, Bars, Gatorade, EAS drinks/bars etc. Sugar & Salt Substitutes Equal, Splenda Sun Tanning Banana Boat Deep Tan Oil SPF4, Suntan lotion, after sun products Coppertone SPF 10 that are less than SPF 15 and/or that do not offer “Broad Spectrum” coverage, do not meet the minimum FDA standard for prevention of skin cancer or premature aging.

Updated April 15, 2020