Fish Oil Tablets & Med Reim

DB · September 2005

An employee states that his doctor has suggested that the employee take fish oil tablets to help reduce his cholesterol. I think this could be submitted as an eligible expense under the employee's cafeteria plan because it's being used to treat a medical condition, not for general good health.

Any other opinions?

Whatever · September 2005

My guess (and I emphasis guess) is that the ee has elevated (not high) cholesterol. He has probably been told to eat right (including foods that include Omega-3). The doctor has suggested the ee take the fish oil tablets. A suggestion is not the same as saying you need to take this. Therefore, (depending on what your plans says) I don't see it as an eligible expense.

System · September 2005

I agree that it's probably not an eligible expense under the group health plan but can probably qualify under a flexible spending account; that is if the doctor will document it. However; if you eat Cheerios for breakfast as a means to lower cholesterol, that would not be covered, doctor's note or not.

Dutch2 · September 2005

Our program states: There are additional filing requirements for plans allowing OTC under the medical FSA:
To claim vitamins, herbs or nutritional supplements, you must have a written diagnosis of the medical condition and "prescription" of all specific items for that condition on file with the claims office. You must renew this physician notice every 12 months and file it with the claims office with the first claim submitted for those items each plan year.
The receipt or documentation from the store must include the name of the drug printed on the receipt. This information must be provided by the store, not just lised by the participant on the receipt or on the claim form.
The participant must indicate the existing or imminent medical condition on the receipt, on the claim form, or on a seperate enclosed statement each time these items are claimed. Purchases for general health will not be accepted.
The plan lists the following as Ineligible Expenses: Insruance premiums, warranties, service agreements, cosmetic procedures or products, health club dues, non-prescription drugs, vitamins and herbs.
Hope this is helpful...

CJinNM · September 2005

I agree with Dutch2, that's how we administer our plan. Many health professionals are now prescribing supplements, and if that professional prescribes it to treat a health condition, it should be an eligible expense.

Sue2 · September 2005

Section 105 of the Internal Revenue Code allows for medicines and drugs purchased by an employee without a physician's prescription. However, amounts paid by an employee for dietary supplements that are merely beneficial to the general health of the employee or the employee's spouse or dependents, are not reimbursable. My understanding is that for supplements to be reimbursable there must be a diagnosis and a physician's "prescription" for the supplement.

TN HR · September 2005

And a physician will not/cannot write a legitimate script for fish oil because it is not listed in the NDC formulary as something that you write an Rx for and is therefore not protocol. I went through this recently with my payroll admin whose doctor recommended she take B-12 daily. Well, she tried to get him to write an Rx and that is where I found this info.

Whatever · September 2005

There is a difference between a recommendation, a suggestion and medical necessity. I had a pregnant ee who due to an underlying medical condition had to take folic acid. Her doctor wrote a narrative explaining why it was medically necessary for her to take this supplement. And while there was technically no prescription, it was covered.

Fish Oil Tablets & Med Reim

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