This information applies to our ICHRA Premium PLUS customers.
Many in-store, over-the-counter, or online items are eligible, but many will need a letter from your doctor. The IRS states that, for reimbursement, medical expenses must be primarily to alleviate or prevent a physical or mental disability or illness. The expense must be to treat the disease rather than promote general health. Since some items and services have multiple purposes, a medical practitioner's note recommending the item or service to treat a specific medical condition is required to show that the expense is primarily for medical care. Nutritional supplements, herbal remedies, vitamins, exercise equipment, and services like massage therapy and gym memberships require a letter of medical necessity. You can click the SEE WHAT’S ELIGIBLE button from your dashboard to search your expense to confirm if a note from your doctor is required 
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Who can write my note?
A physician must write and sign your note to confirm they recommend the service or item and what medical condition it treats. Examples of physicians eligible to write letters are naturopathic doctors (ND, NMD), physician assistants, nurse practitioners, and osteopathic physicians. Please ensure that the physician's qualification abbreviations follow their signature (NMD, ND, NP, MD, PA, DO, etc.). We can’t accept notes from some licensed professionals such as therapists, physical therapists, chiropractors, traditional naturopaths (CTN), and Doctors of Chinese Medicine.What does my note need?
Your note must contain a statement of medical necessity and list all of the specific services and items your doctor recommends. Your doctor needs to date the note because it will only be valid for one year (unless stated otherwise by your doctor). Your doctor may need to backdate your letter to include the service or purchase date. We know getting a note that meets all the requirements can be challenging.
We have attached a printable Letter of Medical Necessity template to make it easier for you.
"I recommend Sally take Vitamin D to treat her vitamin deficiency.”
"I recommend Sally purchase multivitamins/supplements to improve overall health.”
"I recommend Sally get a gym membership to treat or prevent her generalized anxiety disorder."
"I recommend Sally exercise to improve general health.”
“I recommend Sally get an exercise bike for home use to treat her back pain.”
“I recommend Sally exercises 3x times a week to prevent illness.”
“I recommend Sally use Vitamin C to treat her arthritis.”
“I recommend Sally use supplements to treat her arthritis.”
Examples of doctor notes:
- This statement clearly states the supplement needed and the medical reason for needing it.
- This statement is too general. It doesn’t show the exact supplements or vitamins needed, and “overall health” is not a valid medical diagnosis per IRS regulations.
- This statement clearly states that the doctor recommends a gym membership for a medical condition.
- This statement does not state the need for a gym membership nor gives a medical diagnosis for the recommendation.
- This statement explains that the exercise bike is treating a medical condition. Please note that your letter is only suitable for the recommended item. You could not use this note to buy a treadmill or yoga mat.
- This statement would not work for any exercise equipment as it only states a recommendation to exercise. The medical reasoning is not valid either, as it is too general and does not state the current medical condition it is treating.
- This statement recommends a specific product for a particular medical condition.
- While this sentence states a specific medical condition, the recommended treatment is unclear.
The photo above shows the doctor's exact recommendation and the medical need (diagnosis). Other important things to note are the medical abbreviations after the signature and the date. The date of the letter needs to include all the purchase dates you’re requesting. Your doctor may need to backdate your note.
If you’re unsure if we can accept a note for any reason, you can reach out to our support team through your dashboard or by email at support@peoplekeep.com.
Here is a template you can use: