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Calculate your tax savings :
Annual reimbursable expenses

Select Your Annual Income

Select Your Pay Cycle

Healthcare Expenses (estimated)

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Doctor visits and co-pays $
Deductibles $
Prescription drugs $
Over The Counter Medications $
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 $

 

Dependent Care Expenses (estimated)

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Children $
Adults $
Total $

 

Estimated Annual Expenses 
and Tax Savings
Total Healthcare Expenses $
Total Dependent Care Expenses $
Total Annual Expenses $
Annual Tax Savings $
Estimated Savings 
Amount Per Paycheck		 $

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