Enter amounts in whole dollars - no decimal points, or dollar signs (For example: 500).
Enter your Annual Household Income: $
Select your Marital Status:
Select the number of Exemptions:
Enter the number of Pay Periods you have per year:
Please enter your annual FSA eligible estimated expenses for either MEDFLEX or Dependent Care into the fields below (Example: 500).

1. Annual Dependent Care Expenses
Physician/Doctor: $
Osteopathic Physician: $
Chiropractor: $
Podiatrist: $
Other Health Practitioner: $
The tax savings computation is based on 2004 Tax Tables, assumes various tax deductibles, and does not consider state and local taxes. Actual savings will vary based on your individual tax situation. Please consult a tax professional for more information on tax implications of an FSA.