FSA Estimation Calculator

Estimating Your Qualifying Healthcare Expenses
Healthcare Deductibles: $
Healthcare copayments and coinsurance: $
Prescription drugs: $
Vision exams, physicals and immunizations: $
Dental/Orthodontia: $
Routine exams, physicals and immunizations: $
Counseling/Psychotherapy: $
Expenses for disabled dependents: $
Other allowable expenses: $
Total Estimated Healthcare Expenses for the Plan Year $

Estimating Your Dependent Care Expenses
Child daycare expenses: $
Preschool expenses: $
Summer day camp expenses: $
Adult daycare expenses: $
Other eligible expenses: $
Total Estimated Dependent Care Expenses For the Plan Year $

Total Estimated Expenses For the Plan Year: $
Divided by the Number of Pay Periods: /
FSA Premium Per Pay Period:
 $
  

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