ELIGIBLE MEDICAL EXPENSES


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	SAMPLE OF ELIGIBLE OUT-OF-POCKET MEDICAL EXPENSES


	Some items listed above may not be reimbursable under your employers plan. Consult your Summary Plan Description (SPD) for exclusions. Teeth whitening, hair loss drugs and other cosmetic items/procedures are not reimbursable. Over-the-Counter drugs/medicines are not eligible without a prescription. (1) = Requires written documentation from a Physician specifying medical condition and required treatment.


	All claims must be filed with your insurance carrier first. To claim your expenses, an Explanation of Benefits from your insurance carrier is preferred and may be required. Important: The amount you pay your provider at the time of service is not necessarily the amount you will ultimately owe. Your insurance carrier will reduce your out of pocket cost, through network discounts and other predetermined agreements, and a credit will appear on your account.


	To contact us:


	SOUTHERN ADMINISTRATORS AND BENEFIT CONSULTANTS, INC Phone: 601-856-9933