Enter Eligible Health Care Expenses: Step 1 of 4


Any money you contribute to your Flexible Spending Account (FSA) can be used to reimburse you for a number of eligible health care expenses. The information you enter in steps 1 and 2 will be carried over to the FSA Savings Calculator, which will then help calculate how much your FSA will help you save in the plan year.


Next to each eligible expense, estimate what you think your out-of-pocket costs will be for the plan year.


Please note: You may want to print this information to use when you sign up for benefits.






Laser eye surgery









Total Estimated Health Care Expenses
     

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