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Re: Flex Spending Account enrollment and calculation
- To: noelle
- Subject: Re: Flex Spending Account enrollment and calculation
- From: http://dummy.us.eu.org/robert (Robert)
- Date: Sat, 17 Oct 2015 10:30:27 -0700
I'm going to reduce the dentist since I'll try to have this done this
year instead.
BTW, I was reading that our new dental provider will be Delta Dental.
They may cover less from Dr. Takeuchi.
Oh, and, as you know, our revised PPO will have a higher deductible and
higher premiums. And, next year will be the last year they offer PPO.
After that, Health Savings Accounts will be the only option.
> From: http://dummy.us.eu.org/robert (Robert)
> Date: Sat, 10 Oct 2015 09:07:50 -0700
>
> Anything else that needs to be covered?
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Flexible Spending Account
Deduction Worksheet
This worksheet will help you calculate your applicable expenses and how
much money would be in an FSA deduction each pay period.
Medical/Dental/Vision Reimbursement Account
Annual Medical Expenses, such as:
Deductibles and co-pays $ _____________
Routine physical exams $ _____________
Prescriptions $ _____________
Chiropractic care $ _____________
Gastroenterologist $ ___________70
Podiatrist $ __________100
Other $ _____________
Annual Dental Expenses, such as:
Deductibles and co-pays $ __________170
Routine check-ups $ __________280
Orthodontia $ _____________
Other $ _____________
Annual Vision Care Expenses, such as:
Exams $ _____________
Eyeglasses $ __________300
Contact lenses, solutions, cleaners $ _____________
Other $ _____________
Slush $ __________400
Total Estimated $ _________1320
Medical/Dental/Vision Expenses
$ _____________ + _________________ = $ __________
Annual Amount # of Pay Periods* Per Pay Period
(cannot exceed
company max.)
*Weekly, 52 pay periods Biweekly, 26 pay periods Semimonthly,
24 pay periods Monthly, 12 pay periods