Calculate Your FSA Tax Savings

By completing the following information, you can calculate your annual reimbursable expenses.

Select Your Annual Income  
Select Your Pay Cycle  

Healthcare Expenses for you and your dependents (annual estimates)

Chiropractic $
Deductibles $
Dental checkups $
Doctor visits and co-pays $
Eye exams & surgery $
Fillings/crowns $
Glasses/contacts/solutions $
Orthodontia $
Prescribed medical supplies/equipment $
Prescription drugs $
Psychiatric or Psychologist's fees $
Travel to doctor or hospital $
Weight-loss programs
(associated with a specific disease).
Other $
Total $

Dependent Day Care Expenses (annual estimates)

Adults $
Children $
Total $

Total Expenses

Total Healthcare Expenses
(IRS 2019 Health FSA max contribution is $2,700)
Total Dependent Care Expenses
(IRS Dependent Care FSA max contribution is $5,000 per family)
Total Annual Expenses $
Annual Tax Savings $
Estimated Savings Amount Per Paycheck $

Please note: Tax savings amounts are estimated. Please contact your tax advisor for savings amounts specific to your household earnings.