FSA Calculator
Calculate Next Year's Contribution
Follow the steps below to estimate how much to contribute to your Flexible Spending Account (FSA) next year.
Remember, FSA contributions can’t be changed during the plan year unless there is a qualifying event (such as marriage or divorce, birth, death or adoption of a dependent, or change in employment status).
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
|
