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FSA Savings Calculator

How to use your Section 125 Flexible Spending Plan.

Section 125 of the Internal Revenue code allows Employers to sponsor a plan for their Employees that creates PRE-TAX savings through the reduction of:

  • Medical Insurance Premiums
  • Out-of-Pocket Medical Expenses
  • Dependent/Child Care Expenses
  • Personally Paid Health Insurance Premiums

Use the calculator to see what you could save.

Select Your Annual Income
Select Your Pay Cycle

Annual Medical Insurance Premiums (payroll deducted)

Health Insurance $
Vision and/or Dental Insurance $
Group Term Life Insurance $
Other $

Total

$

Annual Healthcare Expenses (estimated) (out-of-pocket un-reimbursed medical)

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

Total

$

Annual Child/Dependent Care Expenses (estimated)

(Annual Maximum Limits of $5,000.00)
Children(s) $
Adult(s) $

Total

$

Annual Adoption Expenses (estimated)

Attorney fees $
Court costs $
Legal adoption fees $
Other $

Total

$

Estimated Annual Expenses and Tax Savings

Total Medical Insurance Premiums $
Total Out-Of-Pocket Medical Expenses $
Total Dependent Care Expenses $
Total Adoption Expenses $

Total Annual Expenses

$


Annual Tax Savings

$


Estimated Savings Amount Per Paycheck

$