Common FSA eligible/ ineligible expenses Using a flexible spending account (FSA) is a great way to pay for eligible expenses with income tax-free dollars.

The following lists are not all-inclusive but will highlight some common eligible expenses for your health care FSA, limited purpose FSA or dependent care FSA. The Internal revenue service (IRS) decides which expenses can be paid from an FSA and they can modify the list at any time. Be sure to review your benefit plan documents to learn what expenses are qualified for reimbursement under your specific plan. Managing your FSA is simple It’s easy to manage your account If you are currently participating in a high-deductible health plan online. Simply register at (HDHP) and are contributing to a health savings account (HSA), you optumbank.com to: may also participate in a limited purpose FSA (LPFSA). Eligible LPFSA expenses are limited to dental and vision. • Sign up to receive email notifications Common eligible health care expenses • Sign up for direct deposit • Acupuncture • Laboratory fees • Check your account balance • Ambulance • Laser eye surgery* • Submit claims and receipts for • Artificial limbs • Medical alert bracelet reimbursement • Artificial teeth* • Medical records charges • View your recent transactions • Birth control treatment • Midwife With an Optum Financial FSA, • Blood sugar test kits for • Occlusal guards to prevent you have the tools and resources diabetics teeth grinding to make the most of your health • Breast pumps and lactation • Orthodontics* care dollars. supplies • Orthotic Inserts (custom or off • Chiropractor the shelf) We’re everywhere you go • Contact lenses and solutions* • (Certain) over-the-counter drugs The Optum Bank mobile app • Crutches and medications is the most convenient way • Physical therapy • Dental treatments including to check your balance, submit X-rays, cleanings, fillings, • Special education services and review claims, and receive sealants, braces and tooth for learning disabilities messages — even when you’re removals* (recommended by a doctor) in line at the pharmacy. You can • Doctor’s office visits and co-pays • Speech therapy snap a photo of a receipt using • Drug addiction treatment • Stop-smoking programs your device’s camera and upload • Drug prescriptions (including nicotine gum or it to your account to document patches, if prescribed) your claim. • Eyeglasses (Rx and reading)* • Surgery, excluding • Fluoride treatments* cosmetic surgery • Flu shots • Vaccines • Guide dogs • Vasectomy • Hearing aids and batteries • Vision exam* • Infertility treatment • Walker, cane • Inpatient alcoholism treatment • Wheelchair • Insulin

*LPFSA-eligible expense Common over-the-counter (OTC) medicines Many over-the-counter medicines and drugs as well as medical supplies may be qualified for reimbursement with a health care FSA. Examples include but are not limited to:

• Acid controllers • Elastic bandages and wraps • The IRS publishes information • Acne medicine • Eye care* on FSAs and qualified medical • Anti-gas products • Feminine antifungal expenses. Visit irs.gov and or anti-itch products • Allergy and sinus medicine search for Publication 502 or 969 • Anti-diarrheal medicine • First-aid supplies to learn more. • Baby rash ointments/creams • Hemorrhoid treatments • View your account information • Bandages, adhesive or elastic • Laxatives or stool softeners at optumbank.com • Braces and supports • Menstrual care products • Breast pumps • Motion sickness medicines • Blood pressure monitors • Nasal sprays or drops • Catheters • Ointments for cuts, burns or rashes • Cold and flu medicine • Ostomy products • Cold packs/hot packs • Pain relievers, such as • Contact lens solution aspirin or ibuprofen and supplies* • Pregnancy test kits • Contraceptives • Sleep aids • Crutches • Stomach remedies • Denture adhesives* • Sunscreen • Diagnostic tests and monitors (such as blood glucose monitors) • Thermometers • Walkers, wheelchairs and canes You do the shopping; we make it easy. Services that may be eligible with a letter of medical necessity Make the most of your FSA form completed dollars at the Optum Store This list is not all-inclusive: Shop store.optum.com for a wide • Weight-loss program, only if it is a treatment for a specific disease selection of all your health and diagnosed by a physician (e.g., obesity, hypertension, heart disease) wellness essentials from the brands you trust. Plus, when you use your • Compression hosiery/socks, anti-embolism socks or hose Optum Financial payment card • Massage treatment for specific ailment or diagnosis — purchases are automatically • CPR classes for adult or child approved, hassle-free. • Improvements or special equipment added to a home or other capital Use code OPTFSA7 to save 7% expenditures for a physically handicapped person storewide, plus free shipping.** • Toothbrushes (including electric) and toothpaste

*LPFSA eligible expense Ineligible expenses Listed below are some services and expenses that are not qualified for FSA reimbursement. This list is not all-inclusive:

• Aromatherapy • Hair re-growth supplies • Baby bottles and cups and/or services • Baby oil • Health club membership dues • Baby wipes • Humidifier • Breast enhancement • Lotion • Cosmetics and skin care • Low-calorie foods • Cotton swabs • Mouthwash • Dental floss • Petroleum jelly • Deodorants • Shampoo and conditioner • Spa salts

Qualified dependent care expenses

• Au pair services • Nursery school • Babysitting services • Pre-kindergarten • Before- and after-school • Summer day camp (not programs educational in nature) • Custodial or eldercare expenses, in-home or daycare center (not medical care)

Ineligible dependent care expenses • Clothing • Kindergarten and higher • Food/meals education/tuition expenses • Overnight camp

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**The promotional code OPTFSA7 cannot be applied to previously placed orders, and cannot be combined with other promotional codes. Promotional codes are not transferable or redeemable for cash or credit. To apply a promotional code you must enter it prior to completing the order. Failure to adhere to these terms of use may result in the transaction being voided. Free and expedited shipping offers do not apply to shipping outside of the contiguous United States. Additional shipping restrictions may apply. The Optum Store is an affiliate of the UnitedHealth Group family of companies. We are now Optum Financial, which includes Optum Bank. Health savings accounts (HSAs) are individual accounts offered or administered by Optum Bank® Member FDIC, a subsidiary of Optum Financial, Inc., and are subject to eligibility requirements and restrictions on deposits and withdrawals to avoid IRS penalties. State taxes may apply. Fees may reduce earnings on account. Flexible spending accounts/arrangements (FSAs) are administered by OptumHealth Financial Services and are subject to eligibility and restrictions. This communication is not intended as legal or tax advice. Federal and state laws and regulations are subject to change. © 2021 Optum, Inc. All rights reserved. WF4506690 40051F-052021 OHC