Calculate Your Tax Savings

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

Select Your Annual Income

Select Your Pay Cycle

Insurance Premiums (only if payroll deducted)
Health Insurance $
Group Term Life Insurance $
Disability coverage $
Vision and/or Dental Insurance $
Other $
Total $

Healthcare Expenses (estimated)

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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 $

Dependent Care Expenses (estimated)

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Children $
Adults $
Total $

Adoption Expenses (estimated)
Attorney fees $
Court costs $
Legal adoption fees $
Other $
Total $

Estimated Annual Expenses and Tax Savings
Total Insurance Premiums $

Less HRA Contributions

If your plan offers an HRA, you will need to deduct the amount that would be eligible for reimbursement under your HRA.

 $
Total Healthcare Expenses $

Less HRA Contributions

If your plan offers an HRA, you will need to deduct the amount that would be eligible for reimbursement under your HRA.

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