Flex Reimbursements Worksheet
A Flexible Spending Account allows you to set aside pre-tax dollars to pay for certain health care and dependent care expenses. By contributing pre-tax dollars to a reimbursement account, you lower your taxable income. As you pay for these expenses, you'll be reimbursed from this fund of pre-tax dollars. The result: you decrease your overall taxes and increase your spendable income.
To take advantage of these savings, please follow these easy steps:
Step 1
Look through the list below and see which expenses you and your family may have that are not completely covered by insurance for the upcoming plan year.
Step 2
Estimate your annual health-related expenses NOT covered under either your benefit plan or your spouse's plan. It may help to review what you paid for eligible services last year. You can use insurance records, tax receipts, your checkbook register, and other personal records.
Step 3
Estimate the annual dependent care expenses that will occur within the upcoming plan year. The maximum per calendar year is $5,000 if filing jointly, $2,500 if married and filing separately.
Step 4
Complete this worksheet with your cestimated Annual Expenses. Take your Total Estimated Annual Cost and divide by the number of payrolls during the plan year. Enter the amount on your enrollment form.