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Specialty Food Eligibility

Dani
Updated

Specialty foods are essential for managing medical conditions like allergies or intolerances. Here's what you need to know about their eligibility for reimbursement through a Health Reimbursement Arrangement (HRA). Be sure to check your plan settings to see if your company requires an Explanation of Benefits (EOB) to be submitted for reimbursement. 

What Qualifies for Reimbursement?

Medical Specialty Foods: These foods are sold to meet specific dietary needs due to medical conditions. They replace regular foods to help manage health issues like allergies or intolerances.

The IRS has specific guidelines on what types of food can be included as medical expenses. Generally, diet food can’t be counted as a medical expense because it substitutes what you normally consume to satisfy your nutritional needs. However, there are exceptions for certain specialty foods.

Specialty foods must meet these criteria to be eligible for HRA reimbursement:

  1. A letter of medical necessity from a doctor: You need a letter from your doctor stating that the specialty food is necessary for your medical condition. We have provided a printable Letter of Medical Necessity template for your convenience. 
  2. Excess Cost: Only the excess cost of the specialty food over the regular version is reimbursable. You'll need to provide proof of the costs for both the specialty and regular versions.
    1. Example: If a specialty food costs $10 and a regular food item costs $6, you can include the $4 difference as a medical expense. 
  3. Basic Staples: Only essential foods that replace regular items are eligible.

Examples of Eligible Foods

  • Lactose-Free Alternatives: Lactose-free cow's milk for those who are lactose intolerant.
  • Gluten-Free Options: Breads and pastas made with rice, quinoa, gluten-free oats, or other gluten-free flours for individuals with celiac disease or gluten sensitivity.

What Doesn't Qualify?

  • Luxury or indulgent items like cookies, cakes, chips, and crackers aren’t eligible for reimbursement.
  • Foods chosen for dietary preferences rather than medical necessity, such as vegan or organic options.
  • Diet food and replacement meals to treat obesity- these foods generally satisfy normal nutritional requirements. 

Knowing the eligibility requirements for specialty foods can help you manage healthcare costs. If you have any questions, contact our support team for assistance.

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