MMC Benefits Handbook
Examples of Eligible Expenses
Some expenses are reimbursable without regard to whether you have satisfied the deductible applicable to you (that is, the individual or family deductible, depending on your level of coverage) under the Marsh & McLennan Companies $1,500 Deductible Plan or $2,850 Deductible Plan, while other expenses are reimbursable only if they are post-deductible qualified medical expenses.
Eligible dental and vision expenses reimbursed without regard to whether you have satisfied the deductible applicable to you under the Marsh & McLennan Companies $1,500 Deductible Plan or $2,850 Deductible Plan include:
  • eye exams, glasses (frames and lenses), contact lenses and solutions for contact lenses, lubricant eye drops, eye patches and reading glasses
  • LASIK eye surgery
  • dental treatment, routine dental care (cleaning, X-rays, fillings, etc.), and over-the-counter products such as denture adhesive, temporary filling and toothache relief (if accompanied by a Letter of Medical Necessity)
  • orthodontia (braces)
  • mouth guards
Examples of preventive medical care expenses reimbursed by the Plan
The following are examples of preventive medical care expenses that may generally be reimbursed without regard to whether you have met your deductible:
  • periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals
  • routine prenatal and well-child care
  • flu shots (if not covered by the Marsh & McLennan Companies $1,500 Deductible Plan, $2,850 Deductible Plan, or any other plan)
  • vaccinations
  • child and adult immunizations
  • tobacco-cessation programs
  • screenings for conditions such as:
    • cancer
    • heart and vascular diseases
    • infectious diseases
    • mental health conditions
    • substance abuse
    • metabolic, nutritional, and endocrine conditions
    • musculoskeletal disorders
    • obstetric and gynecological conditions
    • pediatric conditions
    • vision and hearing disorders
  • preventive over-the-counter expenses, such as:
    • home diagnostic tests or kits for blood pressure, cholesterol screening, diabetes (e.g., glucose monitor), colorectal, HIV
    • smoking-cessation relief, such as patches and gum
    • pre-natal vitamins.
Preventive medical care does not generally include any service or benefit intended to treat an existing illness, injury, or condition.
Examples of post-deductible qualified medical expenses
Qualified medical expenses are reimbursable under the Plan only if they are post-deductible qualified medical expenses. Examples of post-deductible qualified medical expenses include:
  • medical services provided by medical practitioners and that are not covered by another plan
  • charges for medically necessary services not covered by another plan, including but not limited to the following:
    • out-of-pocket expenses
    • copayments
    • coinsurance
    • charges exceeding reasonable and customary amounts
    • charges exceeding plan limits
    • prescription drug charges
    • other non-covered charges
    • all medically necessary prescription drugs and certain other prescription drugs permitted by the IRS (e.g., contraceptives and pre-natal vitamins)
    • dental implants
    • hearing exams, hearing aids
    • cost differences between semi-private and private hospital rooms
    • cost for special medical equipment installed in your home, or for home improvements for purposes of medical care, e.g., ramps, support bars, railings, etc. (if accompanied by Letter of Medical Necessity)
    • fees for special schools on the recommendation of a physician, including schools for the mentally impaired, physically disabled or individuals with severe learning disabilities
    • transportation (amounts paid for travel primarily for, and essential to, medical care)
    • personal use items if primarily used to prevent or alleviate a physical or mental defect or illness, e.g., Braille books, hearing aids
    • private nursing services rendered in your home or elsewhere.
For examples of IRC Section 213 qualified medical expenses, see IRS Publication 502, which is available at www.irs.gov or by calling the IRS at +1 800 829 3676. Note that certain items listed in Publication 502 may not qualify for Limited Purpose Health Care Flexible Spending Account reimbursement, such as premiums for dental or vision insurance. In addition, Publication 502 does not specifically address all of the requirements of Limited Purpose Health Care Flexible Spending Accounts, including post-deductible qualified medical expenses. You may also contact the Claims Administrator for information about reimbursable qualified medical expenses.