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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 EXPENDS: $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 $2,500 for unreimbursed health care expenses and $5,000 for dependent care expenses resulting in a maximum savings of $1,575.00 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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