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
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Annual Estimate
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Deductibles, co-pays, co-insurance
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Physician visits and routine exams
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Prescription drugs
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Over-the-counter items (see notice below)
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Insulin, syringes and diabetic supplies
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Annual physicals
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Chiropractic treatments
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Other medical expenses
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TOTAL MEDICAL EXPENSES:
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$0.00
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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.
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Dental expenses not covered by insurance
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Annual Estimate
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Check ups and cleanings
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Fillings
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Root canals
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Crowns, bridges and dentures
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Oral surgery
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Orthodontia
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Other dental expenses
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TOTAL DENTAL EXPENSES:
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$0.00
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Vision & Hearing Care expenses not covered by insurance
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Annual Estimate
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Exams
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Eyeglasses
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Prescription sunglasses
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Contact lenses and cleaning solutions
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Corrective eye surgery (LASIK, cataract, etc.)
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Hearing exams, aids and batteries
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Other vision or hearing expenses
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TOTAL VISION AND HEARING EXPENSES:
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$0.00
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Total Unreimbursed Healthcare expenses:
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$0.00
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Annual Medical expenses:
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$0.00
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Annual Dental expenses:
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$0.00
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Annual Vision and Hearing expenses:
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$0.00
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Annual Unreimbursed Healthcare expenses:
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$0.00
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Annual Dependent Care expenses:
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$0.00
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Total Annual expenses:
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$0.00
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Increase* in annual spendable income:
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$0.00
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* 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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