Flexible Spending Account (FSA) Calculator
Step 1: Estimate Your Health Plan Copays
$ .00
Enter the number of doctor visits you anticipate during the year for each member on your policy:
$ .00
Step 2: Estimate Your Medication Expenses
Enter your family's monthly out-of-pocket medication expenses:
$ .00
$ .00
$ .00
$ .00
$.00
Step 3: Estimate Your Medical Expenses
Enter your family's annual out-of-pocket medical expenses:
$ .00
$ .00
$ .00
Step 4: Estimate Your Dental Expenses
Enter your family's annual out-of-pocket dental expenses:
$ .00
$ .00
$ .00
$ .00
Step 5: Estimate Your Vision Care Expenses
Enter your family's annual out-of-pocket vision expenses:
$ .00
$ .00
$ .00
$ .00
Step 6: Estimate Your Dependent Care Expenses
Enter your family's weekly dependent care expenses if you also plan to participate in a Dependent Care FSA:
$ .00
$ .00
$ .00
Step 7: Enter Your Number of Pay Periods
How often are you paid? (What is your pay period?)
Your Results: Summary of Your FSA Account Estimates
Based on your estimates above, here are the expenses you plan to submit through your FSA:
| Category | Annually | Per Pay Period |
|---|---|---|
|
Total Health Care Account Contributions:
|
$0.00
|
$0.00
|
|
Total Dependent Care Account Contributions:
|
$0.00
|
$0.00
|
FSA Calc Script and Styles
