FSA Calculator

SALARY INFORMATION
Enter your annual income:	$

HEALTH CARE REIMBURSEMENT ACCOUNT
Enter the amount you expect to pay during the plan year for eligible medical expenses:
Medical deductibles
Medical plan co-payments and co-insurance	$
Dental plan deductibles and co-payments	$
Vision Expenses Including Glasses, Contact Lens, Exams and Supplies	$
Prescription Drugs	$
Orthodontia	$
Other Eligible Expenses	$
Eligible Over the Counter Expenses	$

*Total estimated health care contributions:*:	$

DEPENDENT CARE REIMBURSEMENT ACCOUNT
Enter the amount you expect to spend on eligible dependent care expenses:
Babysitter	$
Day Care Center	$
Nursery/Pre School	$
After-School Care	$
Summer Day Camp	$
Other Eligible Expenses	$

*Total estimated dependent care contributions:*	$

ESTIMATED TAX SAVINGS
Note: Based on 15% Federal income tax, 5% State income tax and 7.65% Social Security tax.
	Without Spending Account		With Spending Account

Annual Income	$		$
Total health care contribution	$		$
Total Dependent Care Contribution	$		$
Taxable income	$		$
Net income	$		$

ESTIMATED SAVINGS:

$