Questions You Can Ask Yourself to Help Determine Your Expenses
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Q uestions You Can Ask Yourself to Help Determine Your Expenses 1. What servi ces have you and your family used in the past year? 2. During the next year, do you expect to have similar expenses or other planned health events, such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic care or diagnostic procedures? 3. Are you planning any maj or li festyle changes in the next year that may affect your health care needs (e.g., marriage, birth or adoption)? 4. What is the amount of your annual health, dental or pharmacy plan deductible? Back D isc laimer Your health plan does not guarantee the accuracy or completeness of the calculator. You will need to evaluate the merits and risks associated with relying on any information provided. Your health plan is not providing investment or tax or legal recommendations, advice or endorsem ents. This calculator is intended to give you an idea of the impact of participating in a Flexible Spending Account. However, you will need to make the final decision about whether to contribute. In deciding how much to contribute, keep in mind that unused Flexible Spending Account contributions will be forfeited. Actual Federal Withholding amounts, FICA amounts and tax savings will vary based on your individual tax situation. Please consult a tax professional for more information. Back St ep 1: Financial Information I Health Care I Dental Care I Drug I Vision Car e I Dependent Care I Tax Savings Flexible Spending Account (FSA) Calculator Use this tool to determine if a Flexible Spending Account is right for you. You can estimate your contributions and calculate potential tax savings. Step 1: Financial Information Please answer these questions to determine your potential tax savings. Household Gross Income: 0.00 $___________ (Income before taxes) Filing Status: Single Married - Jointly (or qualified Widow) Married - Separate Head of Household Flexible Spending Account Maximums: 0.00 Medical Reimbursement: $___________ I don't know. 0.00 $___________ I don't know. Dependent Care: Be sure to check your benefits booklet or ask your Human Resources department to find out your maximum contribution amounts. Clear Read the calculator tool disclaimer. Next Step 2: Financial Informati on I Heal th Car e I Dental Care I Drug I Vision Car e I Dependent Care I Tax Savings Step 2: Health Care Expenses To help you decide how much money to put in your Flexible Spending Account, enter your anticipated out-of-pocket health care costs for this year. To make this easier, you may base these estimates on your actual expenses from last year. Because you will lose any unused amounts at the end of the plan year, you may want to be conservative in estimating these expenses. Last Year This Year 0.00 $___________ 0.00 $___________ Routine office visits 0.00 $___________ 0.00 $___________ Specialist visits 0.00 $___________ 0.00 $___________ Chiropractor/Acupuncturist visits 0.00 $___________ 0.00 $___________ Fertility Treatments 0.00 $___________ 0.00 $___________ Surgery 0.00 $___________ 0.00 $___________ Therapy sessions 0.00 $___________ 0.00 $___________ Other eligible expenses (view) 0.00 $___________ 0.00 $___________ Health Care Expense Total 0.00 $___________ 0.00 $___________ Expense Health Deductible Out-of-Pocket Cost for: Back Clear Next Step 3: Financial Informati on I Heal th Care I Dental Car e I Dr ug I Vision Care I Dependent Car e I Tax Savings Step 3: Dental Care Expenses Enter your anticipated out-of-pocket dental costs for this year. Because you will lose any unused amounts at the end of the plan year, you may want to be conservative in estimating these expenses. Last Year This Year 0.00 $___________ 0.00 $___________ Routine office visits 0.00 $___________ 0.00 $___________ Additional dental care 0.00 $___________ 0.00 $___________ Orthodontic services 0.00 $___________ 0.00 $___________ Other eligible expenses (view) 0.00 $___________ 0.00 $___________ Dental Care Expense Total 0.00 $___________ 0.00 $___________ Medical Expense Total 0.00 $___________ 0.00 $___________ Expense Dental Deductible (if separate from Health Deductible) Out-of-Pocket Cost for: Back Clear Next Step 4: Financial Informati on I Heal th Care I Dental Care I Dr ug I Vi sion Care I Dependent Care I Tax Savi ngs Step 4: Prescription and Over-the-Counter (OTC) Drug Expenses Enter your anticipated out-of-pocket prescription and OTC drug costs for this year. Because you will lose any unused amounts at the end of the plan year, you may want to be conservative in estimating these expenses. Expense Last Year This Year 0.00 $___________ 0.00 $___________ Pharmacy prescriptions 0.00 $___________ 0.00 $___________ Mail-order prescriptions 0.00 $___________ 0.00 $___________ OTC medications 0.00 $___________ 0.00 $___________ Other eligible expenses (view) 0.00 $___________ 0.00 $___________ Drug Expense Total 0.00 $___________ 0.00 $___________ Medical Expense Total 0.00 $___________ 0.00 $___________ Prescription Drug Deductible (if separate from Health Deductible) Out-of-Pocket Cost for: Back Clear Next Step 5: Financial Informati on I Heal th Care I Dental Care I Dr ug I Vi sion Car e I Dependent Care I Tax Savings Step 5: Vision Care Expenses Enter your anticipated out-of-pocket vision care costs for this year. Because you will lose any unused amounts at the end of the plan year, you may want to be conservative in estimating these expenses. Last Year This Year 0.00 $___________ 0.00 $___________ Routine eye exams 0.00 $___________ 0.00 $___________ Eyeglasses and/or contact lenses 0.00 $___________ 0.00 $___________ LASIK surgery 0.00 $___________ 0.00 $___________ Other eligible expenses (view) 0.00 $___________ 0.00 $___________ Vision Care Expense Total 0.00 $___________ 0.00 $___________ Medical Expense Total 0.00 $___________ 0.00 $___________ Expense Vision Deductible (if separate from Health Deductible) Out-of-Pocket Cost for: Back Clear Next Step 6: Financial Informati on I Heal th Care I Dental Care I Dr ug I Vi sion Care I Dependent Care I Tax Savings Step 6: Dependent Care Expenses Enter your anticipated out-of-pocket dependent care costs for this year. Because you will lose any unused amounts at the end of the plan year, you may want to be conservative in estimating these expenses. Expense Last Year This Year Child care 0.00 $___________ 0.00 $___________ Pre-school tuition 0.00 $___________ 0.00 $___________ Adult care 0.00 $___________ 0.00 $___________ Other eligible expenses (view) 0.00 $___________ 0.00 $___________ Dependent Care Total 0.00 $___________ 0.00 $___________ Medical Expense Total 0.00 $___________ 0.00 $___________ Out-of-Pocket Cost for: Back Clear Next Step 7: Financial Informati on I Health Care I Dental Care I Dr ug I Vi sion Care I Dependent Car e I Tax Savi ngs Step 7: Tax Savings From the information you entered on the previous screens, it appears you anticipate unreimbursed expenses in the following amounts for the coming year. You may want to consider funding your account(s) with the following amounts: M edical FSA: 0.00 $___________ Dependent Care FSA: 0.00 $___________ Be sure to check your benefits booklet or ask your Human Resources department to find out your maximum contribution amounts. With Spending Account(s) Without Spending Account(s) Gross Annual Income: 0.00 $___________ 0.00 $___________ Est. Medical Care Expenses (pre-tax) 0.00 $___________ 0.00 $___________ Est. Dependent Care Expenses (pre-tax) 0.00 $___________ 0.00 $___________ Taxable Income 0.00 $___________ 0.00 $___________ Estimated Federal Wi thholding * 0.00 $___________ 0.00 $___________ Estimated FICA * 0.00 $___________ 0.00 $___________ E st. Medical Care Expenses (after tax) 0.00 $___________ 0.00 $___________ E st . Dependent Care E xpenses (after tax) 0.00 $___________ 0.00 $___________ Net Income (spendable income) 0.00 $___________ 0.00 $___________ Tax Savings * 0.00 $___________ 0.00 $___________ Back Back Back Print Start Over * R ead the calcu la to r to ol disclaimer. D isc laimer Your health plan does not guarantee the accuracy or completeness of the calculator. You will need to evaluate the merits and risks associated with relying on any information provided. Your health plan is not providing investment or tax or legal recommendations, advice or endorsem ents. This calculator is intended to give you an idea of the impact of participating in a Flexible Spending Account. However, you will need to make the final decision about whether to contribute. In deciding how much to contribute, keep in mind that unused Flexible Spending Account contributions will be forfeited. Actual Federal Withholding amounts, FICA amounts and tax savings will vary based on your individual tax situation. Please consult a tax professional for more information. Back 2007 IRS Qualifying Medical Expenses Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code. The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹ Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional. Eligible Medical Expenses (For FSA Distributions) § § § § § § § § § § § § § § § § § § § § § § § § § § § § Abdominal supports Abortion Acupuncture Air conditioner (when necessary for relief from difficulty in breathing) Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Birth control pills (by prescription) Blood tests Blood transfusions Braces Cardiographs Chiropractor Christian Science practitioner Contact lenses Contraceptive devices (by prescription) Convalescent home (for medical treatment only) Crutches Dental treatment Dental x-rays Dentures Dermatologist Diagnostic fees Drug addiction therapy Drugs (prescription) § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Elastic hosiery (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatment Lab tests Lead paint removal Legal fees Lodging (away from home for outpatient care) Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor's expenses) Orthopedic shoes Orthopedist Osteopath § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Registered nurse Special school costs for the handicapped Spinal fluid test Splints Sterilization Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultra-violet ray treatment Vaccines Vasectomy Vitamins (if prescribed) Wheelchair X-rays Eligible Over-the -Counter Drugs (For FSA Distributions) § § § § § § Antacids Allergy medications Pain relievers Cold medicine Anti-diarrhea medicine Cough drops and throat lozenges § § § § § § Sinus medications and nasal sprays Nicotine medications and nasal sprays Pedialyte First aid creams Calamine lotion Stop-smoking programs § § § § § Wart removal medication Antibiotic ointments Suppositories and creams for hemorrhoids Sleep aids Motion sickness pills Ineligible Medical Expenses § § § § § § § § Advance payment for services to be rendered next year Athletic club membership Automobile insurance premium allocable to medical coverage Boarding school fees Bottled water Commuting expenses of a disabled person Cosmetic surgery and procedures Cosmetics, hygiene products and similar items § § § § § § § § Funeral, cremation, or burial expenses Health programs offered by resort hotels, health clubs, and gyms Illegal operations and treatments Illegally procured drugs Maternity clothes Premiums for life insurance, income protection, disability, loss of limbs, sight or similar benefits Scientology counseling Social activities § § § § § § Special foods and beverages Specially designed car for the handicapped other than an autoette or special equipment Swimming pool Travel for general health improvement Tuition and travel expenses to send a child to a particular school Weight loss programs Ineligible Over-the-Counter Drugs § § § § Toiletries (including toothpaste) Acne treatments Lip balm (including ChapStick or Carmex) Cosmetics (including face cream and moisturizer) § § § § Suntan lotion Medicated shampoos and soaps Vitamins (daily) Fiber supplements Back § § § Dietary supplements Weight loss drugs for general well being Herbs 2007 IRS Qualifying Medical Expenses Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code. The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹ Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional. Eligible Medical Expenses (For FSA Distributions) § § § § § § § § § § § § § § § § § § § § § § § § § § § § Abdominal supports Abortion Acupuncture Air conditioner (when necessary for relief from difficulty in breathing) Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Birth control pills (by prescription) Blood tests Blood transfusions Braces Cardiographs Chiropractor Christian Science practitioner Contact lenses Contraceptive devices (by prescription) Convalescent home (for medical treatment only) Crutches Dental treatment Dental x-rays Dentures Dermatologist Diagnostic fees Drug addiction therapy Drugs (prescription) § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Elastic hosiery (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatment Lab tests Lead paint removal Legal fees Lodging (away from home for outpatient care) Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor's expenses) Orthopedic shoes Orthopedist Osteopath § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Registered nurse Special school costs for the handicapped Spinal fluid test Splints Sterilization Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultra-violet ray treatment Vaccines Vasectomy Vitamins (if prescribed) Wheelchair X-rays Eligible Over-the -Counter Drugs (For FSA Distributions) § § § § § § Antacids Allergy medications Pain relievers Cold medicine Anti-diarrhea medicine Cough drops and throat lozenges § § § § § § Sinus medications and nasal sprays Nicotine medications and nasal sprays Pedialyte First aid creams Calamine lotion Stop-smoking programs § § § § § Wart removal medication Antibiotic ointments Suppositories and creams for hemorrhoids Sleep aids Motion sickness pills Ineligible Medical Expenses § § § § § § § § Advance payment for services to be rendered next year Athletic club membership Automobile insurance premium allocable to medical coverage Boarding school fees Bottled water Commuting expenses of a disabled person Cosmetic surgery and procedures Cosmetics, hygiene products and similar items § § § § § § § § Funeral, cremation, or burial expenses Health programs offered by resort hotels, health clubs, and gyms Illegal operations and treatments Illegally procured drugs Maternity clothes Premiums for life insurance, income protection, disability, loss of limbs, sight or similar benefits Scientology counseling Social activities § § § § § § Special foods and beverages Specially designed car for the handicapped other than an autoette or special equipment Swimming pool Travel for general health improvement Tuition and travel expenses to send a child to a particular school Weight loss programs Ineligible Over-the-Counter Drugs § § § § Toiletries (including toothpaste) Acne treatments Lip balm (including ChapStick or Carmex) Cosmetics (including face cream and moisturizer) § § § § Suntan lotion Medicated shampoos and soaps Vitamins (daily) Fiber supplements Back § § § Dietary supplements Weight loss drugs for general well being Herbs 2007 IRS Qualifying Medical Expenses Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code. The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹ Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional. Eligible Medical Expenses (For FSA Distributions) § § § § § § § § § § § § § § § § § § § § § § § § § § § § Abdominal supports Abortion Acupuncture Air conditioner (when necessary for relief from difficulty in breathing) Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Birth control pills (by prescription) Blood tests Blood transfusions Braces Cardiographs Chiropractor Christian Science practitioner Contact lenses Contraceptive devices (by prescription) Convalescent home (for medical treatment only) Crutches Dental treatment Dental x-rays Dentures Dermatologist Diagnostic fees Drug addiction therapy Drugs (prescription) § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Elastic hosiery (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatment Lab tests Lead paint removal Legal fees Lodging (away from home for outpatient care) Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor's expenses) Orthopedic shoes Orthopedist Osteopath § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Registered nurse Special school costs for the handicapped Spinal fluid test Splints Sterilization Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultra-violet ray treatment Vaccines Vasectomy Vitamins (if prescribed) Wheelchair X-rays Eligible Over-the -Counter Drugs (For FSA Distributions) § § § § § § Antacids Allergy medications Pain relievers Cold medicine Anti-diarrhea medicine Cough drops and throat lozenges § § § § § § Sinus medications and nasal sprays Nicotine medications and nasal sprays Pedialyte First aid creams Calamine lotion Stop-smoking programs § § § § § Wart removal medication Antibiotic ointments Suppositories and creams for hemorrhoids Sleep aids Motion sickness pills Ineligible Medical Expenses § § § § § § § § Advance payment for services to be rendered next year Athletic club membership Automobile insurance premium allocable to medical coverage Boarding school fees Bottled water Commuting expenses of a disabled person Cosmetic surgery and procedures Cosmetics, hygiene products and similar items § § § § § § § § Funeral, cremation, or burial expenses Health programs offered by resort hotels, health clubs, and gyms Illegal operations and treatments Illegally procured drugs Maternity clothes Premiums for life insurance, income protection, disability, loss of limbs, sight or similar benefits Scientology counseling Social activities § § § § § § Special foods and beverages Specially designed car for the handicapped other than an autoette or special equipment Swimming pool Travel for general health improvement Tuition and travel expenses to send a child to a particular school Weight loss programs Ineligible Over-the-Counter Drugs § § § § Toiletries (including toothpaste) Acne treatments Lip balm (including ChapStick or Carmex) Cosmetics (including face cream and moisturizer) § § § § Suntan lotion Medicated shampoos and soaps Vitamins (daily) Fiber supplements Back § § § Dietary supplements Weight loss drugs for general well being Herbs 2007 IRS Qualifying Medical Expenses Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code. The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹ Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional. Eligible Medical Expenses (For FSA Distributions) § § § § § § § § § § § § § § § § § § § § § § § § § § § § Abdominal supports Abortion Acupuncture Air conditioner (when necessary for relief from difficulty in breathing) Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Birth control pills (by prescription) Blood tests Blood transfusions Braces Cardiographs Chiropractor Christian Science practitioner Contact lenses Contraceptive devices (by prescription) Convalescent home (for medical treatment only) Crutches Dental treatment Dental x-rays Dentures Dermatologist Diagnostic fees Drug addiction therapy Drugs (prescription) § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Elastic hosiery (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatment Lab tests Lead paint removal Legal fees Lodging (away from home for outpatient care) Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor's expenses) Orthopedic shoes Orthopedist Osteopath § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Registered nurse Special school costs for the handicapped Spinal fluid test Splints Sterilization Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultra-violet ray treatment Vaccines Vasectomy Vitamins (if prescribed) Wheelchair X-rays Eligible Over-the -Counter Drugs (For FSA Distributions) § § § § § § Antacids Allergy medications Pain relievers Cold medicine Anti-diarrhea medicine Cough drops and throat lozenges § § § § § § Sinus medications and nasal sprays Nicotine medications and nasal sprays Pedialyte First aid creams Calamine lotion Stop-smoking programs § § § § § Wart removal medication Antibiotic ointments Suppositories and creams for hemorrhoids Sleep aids Motion sickness pills Ineligible Medical Expenses § § § § § § § § Advance payment for services to be rendered next year Athletic club membership Automobile insurance premium allocable to medical coverage Boarding school fees Bottled water Commuting expenses of a disabled person Cosmetic surgery and procedures Cosmetics, hygiene products and similar items § § § § § § § § Funeral, cremation, or burial expenses Health programs offered by resort hotels, health clubs, and gyms Illegal operations and treatments Illegally procured drugs Maternity clothes Premiums for life insurance, income protection, disability, loss of limbs, sight or similar benefits Scientology counseling Social activities § § § § § § Special foods and beverages Specially designed car for the handicapped other than an autoette or special equipment Swimming pool Travel for general health improvement Tuition and travel expenses to send a child to a particular school Weight loss programs Ineligible Over-the-Counter Drugs § § § § Toiletries (including toothpaste) Acne treatments Lip balm (including ChapStick or Carmex) Cosmetics (including face cream and moisturizer) § § § § Suntan lotion Medicated shampoos and soaps Vitamins (daily) Fiber supplements Back § § § Dietary supplements Weight loss drugs for general well being Herbs 2007 IRS Qualifying Medical Expenses Eligible medical expenses are those you pay for care as described in Section 213(d) of the Internal Revenue Code. The IRS has also allowed some over-the-counter drugs to qualify as eligible medical expenses.¹ Your health plan has created the following lists to help you determine whether an expense is eligible or not. We provide these lists with the understanding that your health plan is not engaged in rendering tax advice. These lists serve as a quick reference. For more detailed information, please refer to IRS Publication 502 or contact a tax professional. Eligible Medical Expenses (For FSA Distributions) § § § § § § § § § § § § § § § § § § § § § § § § § § § § Abdominal supports Abortion Acupuncture Air conditioner (when necessary for relief from difficulty in breathing) Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Birth control pills (by prescription) Blood tests Blood transfusions Braces Cardiographs Chiropractor Christian Science practitioner Contact lenses Contraceptive devices (by prescription) Convalescent home (for medical treatment only) Crutches Dental treatment Dental x-rays Dentures Dermatologist Diagnostic fees Drug addiction therapy Drugs (prescription) § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Elastic hosiery (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatment Lab tests Lead paint removal Legal fees Lodging (away from home for outpatient care) Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor's expenses) Orthopedic shoes Orthopedist Osteopath § § § § § § § § § § § § § § § § § § § § § § § § § § § § § Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Registered nurse Special school costs for the handicapped Spinal fluid test Splints Sterilization Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultra-violet ray treatment Vaccines Vasectomy Vitamins (if prescribed) Wheelchair X-rays Eligible Over-the -Counter Drugs (For FSA Distributions) § § § § § § Antacids Allergy medications Pain relievers Cold medicine Anti-diarrhea medicine Cough drops and throat lozenges § § § § § § Sinus medications and nasal sprays Nicotine medications and nasal sprays Pedialyte First aid creams Calamine lotion Stop-smoking programs § § § § § Wart removal medication Antibiotic ointments Suppositories and creams for hemorrhoids Sleep aids Motion sickness pills Ineligible Medical Expenses § § § § § § § § Advance payment for services to be rendered next year Athletic club membership Automobile insurance premium allocable to medical coverage Boarding school fees Bottled water Commuting expenses of a disabled person Cosmetic surgery and procedures Cosmetics, hygiene products and similar items § § § § § § § § Funeral, cremation, or burial expenses Health programs offered by resort hotels, health clubs, and gyms Illegal operations and treatments Illegally procured drugs Maternity clothes Premiums for life insurance, income protection, disability, loss of limbs, sight or similar benefits Scientology counseling Social activities § § § § § § Special foods and beverages Specially designed car for the handicapped other than an autoette or special equipment Swimming pool Travel for general health improvement Tuition and travel expenses to send a child to a particular school Weight loss programs Ineligible Over-the-Counter Drugs § § § § Toiletries (including toothpaste) Acne treatments Lip balm (including ChapStick or Carmex) Cosmetics (including face cream and moisturizer) § § § § Suntan lotion Medicated shampoos and soaps Vitamins (daily) Fiber supplements Back § § § Dietary supplements Weight loss drugs for general well being Herbs Q uestions You Can Ask Yourself to Help Determine Your Expenses 1. What servi ces have you and your family used in the past year? 2. During the next year, do you expect to have similar expenses or other planned health events, such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic care or diagnostic procedures? 3. Are you planning any maj or li festyle changes in the next year that may affect your health care needs (e.g., marriage, birth or adoption)? 4. What is the amount of your annual health, dental or pharmacy plan deductible? Back Q uestions You Can Ask Yourself to Help Determine Your Expenses 1. What servi ces have you and your family used in the past year? 2. During the next year, do you expect to have similar expenses or other planned health events, such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic care or diagnostic procedures? 3. Are you planning any maj or li festyle changes in the next year that may affect your health care needs (e.g., marriage, birth or adoption)? 4. What is the amount of your annual health, dental or pharmacy plan deductible? Back Q uestions You Can Ask Yourself to Help Determine Your Expenses 1. What servi ces have you and your family used in the past year? 2. During the next year, do you expect to have similar expenses or other planned health events, such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic care or diagnostic procedures? 3. Are you planning any maj or li festyle changes in the next year that may affect your health care needs (e.g., marriage, birth or adoption)? 4. What is the amount of your annual health, dental or pharmacy plan deductible? Back Q uestions You Can Ask Yourself to Help Determine Your Expenses 1. What servi ces have you and your family used in the past year? 2. During the next year, do you expect to have similar expenses or other planned health events, such as knee or back surgeries, allergy injections, immunizations, physical therapy, chiropractic care or diagnostic procedures? 3. Are you planning any maj or li festyle changes in the next year that may affect your health care needs (e.g., marriage, birth or adoption)? 4. What is the amount of your annual health, dental or pharmacy plan deductible? Back
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