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Savings Calculator

The Savings Calculator will help you itemize unreimbursed health and dependent care expenses to assist you in determining your health care spending account contributions and potential increase in savings.

Unreimbursed Healthcare Expenses

This worksheet will help you determine your unreimbursed healthcare expenses during the plan year.

Medical expenses not covered by insurance Annual Estimate
Deductibles, co-pays, co-insurance
Physician visits and routine exams
Prescription drugs
Over-the-counter items (see notice below)
Insulin, syringes and diabetic supplies
Annual physicals
Chiropractic treatments
Other medical expenses
TOTAL MEDICAL EXPENSES: $0.00
Over-the-Counter (OTC) Notice: Effective January 1, 2011, an OTC drug and medicine purchase will require a prescription to be reimbursed as an eligible healthcare expense. Examples of drugs and medicines requiring a prescription are items such as cough or cold medicine, pain relievers, and allergy or sinus medications. Items that will continue to be reimbursed without a prescription include bandages, saline solutions, insulin and diabetic supplies, and diagnostic test kits.
Dental expenses not covered by insurance Annual Estimate
Check ups and cleanings
Fillings
Root canals
Crowns, bridges and dentures
Oral surgery
Orthodontia
Other dental expenses
TOTAL DENTAL EXPENSES: $0.00
Vision & Hearing Care expenses not covered by insurance Annual Estimate
Exams
Eyeglasses
Prescription sunglasses
Contact lenses and cleaning solutions
Corrective eye surgery (LASIK, cataract, etc.)
Hearing exams, aids and batteries
Other vision or hearing expenses
TOTAL VISION AND HEARING EXPENSES: $0.00
Total Unreimbursed Healthcare expenses: $0.00

Dependent Care Expenses

This worksheet will help you determine your annual expense for dependent care during the plan year. Keep the following in mind when estimating your expenses:

  • Amounts you pay for dependent care while you are off work due to vacation, holidays, illness or injury are not eligible expenses.
  • If your dependent is a student, your expense may be different during the months when school is not in session.
  • Your or your spouse's work schedule may affect your total expenses.
  • Estimate your expenses on a monthly basis since the amounts may fluctuate throughout the plan year.
  Monthly Estimate
January
February
March
April
May
June
July
August
September
October
November
December
Total Dependent Care expenses: $0.00

Annual Medical expenses: $0.00
Annual Dental expenses: $0.00
Annual Vision and Hearing expenses: $0.00
Annual Unreimbursed Healthcare expenses: $0.00
Annual Dependent Care expenses: $0.00
Total Annual expenses: $0.00
Increase* in annual spendable income: $0.00

* Savings estimates assumes plan limits of $2,550 for unreimbursed health care expenses and $5,000 for dependent care expenses resulting in a maximum savings of $1,585.50 These are typical plan limits but you should consult with your employer to determine the exact limits defined by your plan. For purposes of this calculation, a savings of 21% is used to assume Federal, state and social security taxes avoided by making pre-tax contributions. Please be advised that this calculation is only an estimate and is not tax advice. Be sure to consult a tax advisor to determine actual savings you may achieve by making pre-tax contributions. Actual tax savings depends on several variables, including state and local tax rates and your individual tax bracket.

Please contact your employer's benefits representative if you have questions concerning how your employer's plan offering works or with questions regarding whether specific types of expenses are covered under it. Carefully plan your contribution. Remember with an FSA, any unused funds will be forfeited following the end of your plan year.

 
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