I decided to lower the amount since the costs are less than I thought and you won't be doing some of the stuff I will be. > From: http://dummy.us.eu.org/robert (Robert) > Date: Sun, 28 Oct 2018 12:12:59 -0700 > > Anything else that needs to be covered? > > ------------------------------------------------------------------------------- > > 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 $ ___________70 > Prescriptions $ _____________ > Chiropractic care $ _____________ > Gastroenterologist $ _____________ > Podiatrist $ _____________ > Ophthamologist $ __________140 > Audiologist $ ___________70 > Other $ _____________ > Annual Dental Expenses, such as: > Deductibles and co-pays $ _____________ > Routine check-ups $ __________140 > Orthodontia $ _____________ > Other $ _____________ > Annual Vision Care Expenses, such as: > Exams $ ___________20 > Eyeglasses $ __________420 > Contact lenses, solutions, cleaners $ _____________ > Other $ _____________ > Slush $ __________500 > Rolled Over from Last Year $ _____________ > Total Estimated $ _________1360 > 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 >