FSA Calculator

We will not capture, record, or use for our own purposes
any information entered into this calculator by you.
Before enrolling in your Company’s Flexible Spending Account plan, you may want to determine how much money you could save by doing so. The following worksheet will help you estimate your potential tax savings by signing up for a Flexible Spending Account.
How many times do you get paid in a year?
What is your annual salary?
Estimated Health Care Expenses      Covered and Excluded Expenses
Doctor's office visits and co-payments $
Medical Plan Deductibles $
Weight-loss programs (associated with a disease) $
Prescription Drugs $
Prescribed medical supplies/equipment $
Medical Transportation ( to doctor or hospital ) $
Vision examinations and Eye surgery $
Eyeglasses, Contact lenses/solutions $
Dental examination/checkups $
Crowns and Fillings $
Orthodontia $
Chiropractic Services $
Psychiatric or Psychologist's Services $
Other Services $
Total* $
Estimated Dependent Care Expenses      Covered and Excluded Expenses
Children $
Adults $
Total* (capped at $5,000) $
Estimated Annual Savings  
*Total Health Care Expenses $
*Total Dependent Care Expenses (capped at $5,000) $
Total Annual Expenses $
Savings Per Paycheck $
Annual Tax Savings $
Recommended Annual Deduction $
Recommended Per Pay Check Deduction $
 

* Health Care and Dependent Care maximum election amounts may vary. Please check with your Human Resources Department to verify maximum election limits.