Health Care Flexible Spending Account Estimator

Enter your expected health care expenses for 2010 (January 1 - December 31) that are eligible for reimbursement under the Health Care Flexible Spending Account. Information about eligible expenses is available at www.irs.gov in IRS Publication 502.

Please enter amounts in whole dollars (no decimal point, comma or dollar sign).

Types of Health Care Expenses 2010 Projected Health Care Expenses
Medical deductibles, copayments and coinsurance, as well as your cost for expenses that are not covered by a medical plan (your total cost of care from the Medical Plan Estimator other than annual deductions from paychecks) or another medical plan in which you are enrolled: $
Over-the-counter medications used to treat a medical condition: $
Vision care expenses, including Vision Plan copayments and other qualified expenses not covered by a vision or medical benefit: $
Dental Plan deductibles and coinsurance (your share of the total cost for covered services including orthodontics, after the deductible is met): $
Other qualified dental expenses not covered by the Dental Plan: $
Any other health care expenses not reimbursed by a health plan that could qualify as a deductible expense on your federal income tax return: $

Income Tax Filing Information (to help estimate your tax savings)
Filing status (required field): Number of dependents:
Do not include yourself or your spouse.
Total annual income:
Enter estimated income for 2010 from all sources you would include on your tax form, including wages, bonus, investment income, etc. Include income for your spouse if your filing status is "Married (joint)."

Do not include a decimal point, comma or dollar sign when entering income.

$

Calculate/Recalculate to determine the following:

Your Results
Total projected out-of-pocket costs for medical, dental and vision care: $
Suggested annual Health Care Flexible Spending Account contribution amount based on total projected expenses (Maximum contribution is $5,000): $
Potential federal income tax savings: $
Potential FICA tax savings: $
Total tax savings:
Depending on where you live/work, you may also have state tax savings		 $

form and enter new projection amounts. To modify a current scenario, simply adjust the numbers above and click the Calculate/Re-calculate button.

Note: This Health Care Flexible Spending Account Estimator is an estimating tool only. Estimate your out-of-pocket expenses carefully. You cannot change your contribution amount after enrollment ends, unless you experience a qualified status change. You forfeit any money you have not claimed by the claim filing deadline for the plan year.

Using this tool does not enroll you in a medical plan or the Health Care Flexible Spending Account.