FSA Worksheet Tab
Use the FSA Worksheet tab to enter your estimated out-of-pocket expenses for insurance deductibles, prescription drugs, vision care, and other relevant categories.
To use the total amount of your estimates, click Use Estimate. Your total estimate figure is applied to the New Contribution - Annual field of the Medical FSA tab.
The following is a list of common (Out-of-Pocket) health care expenses:
- Insurance/Deductibles
- Co-Payments/Co-Insurance
- Prescription Drugs
- Diabetic supplies, medical devices, eye glasses, contact lenses, and others
- Therapy and Treatment
- Dental and Orthodontia
- Vision Care
- Hearing Care
- Other Eligible Health Care Expenses
Note: This is not an all-inclusive listing of eligible expenses. Please refer to www.irs.gov for a complete list.