FSA Calculator

Medical

Dental

Vision

Pharmacy &
Over-the-Counter

Dependent
Care

Results

Health Care FSA Contribution

Dependent Care FSA Contribution

Estimated Tax
Savings

Information About Me

By entering your income, filing status, etc. we can more accurately estimate your tax savings.

FSA Calculator

Information About Me

Income

*required
Employer Contribution Max

( $100 - $99,999 )
Tax Filing Status

Single

Married filing separately

Married filing jointly

Head of household
Do you plan to enroll in a HSA
(Health Savings Account)? Why do we ask this?

No

Yes
Do you use dependant care or
adult day care? Why do we ask this?

No

Yes

Information About Me

By entering your income, filing status, etc. we can more accurately estimate your tax savings.

FSA Calculator

Medical Expenses

Enter the amount you expect to pay out of pocket for:

Copays, coinsurance, and deductibles
Hospitalization or surgery
Chiropractor / acupuncture
Counseling / therapy
Maternity / Infertility
Other
Don't know what is allowed for reimbursement? Visit www.cigna.com/expenses for our very detailed list of eligible and in-eligible expenses.

FSA Calculator

Dental Expenses

Enter the amount you expect to pay out of pocket for:

Routine Dental Care
Specialty Dental Care
Orthodontics
Don't know what is allowed for reimbursement? Visit www.cigna.com/expenses for our very detailed list of eligible and in-eligible expenses.

FSA Calculator

Vision Expenses

Enter the amount you expect to pay out of pocket for:

Routine Eye Care
Eyeglasses
Contact Lenses & Solution
Corrective Eye Surgery

FSA Calculator

Pharmacy Expenses

Enter the amount you expect to pay out of pocket for:

Prescription drugs (coinsurance & copays)

Over-the-Counter Item Expenses

Over-the-counter items
Don't know what is allowed for reimbursement? Visit www.cigna.com/expenses for our very detailed list of eligible and in-eligible expenses.

FSA Calculator

Dependent Care Expenses

Day Care (Child or Adult Dependent)
Licensed Elder Care Facility
Babysitter during work hours
Child care center or nursery school
Taxes paid for care provider

FSA Calculator

Now What?

If you choose to contribute the goal amounts to the FSA...

Your health care FSA contribution amount

$10,000

Your dependent care FSA contribution amount

You will have:

Immediate access to your health care funds
Direct deposit for your FSA reimbursements
Estimated tax savings of $0

	With FSA	Without FSA
Income	$0	$0
Pre-tax health care expenses	$0	$0
Pre-tax dependent care expenses	$0	$0
Taxable income	$0	$0
Estimated federal income taxes	$0	$0
FICA tax (Social Security & Medicare)	$0	$0
Post-tax health care expenses	$0	$0
Post-tax dependent care expenses	$0	$0
Net Pay	$0	$0
ESTIMATED TAX SAVINGS$0

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© CIGNA Estimated tax savings are provided for illustrative purposes only. You are responsible for verifying the accuracy and suitability of all assumptions and calculations. Please seek the advice of licensed and/or competent individuals before making any financial planning decisions. Contact your employer's benefit representative if you have questions concering how your plan works or with questions on whether specific types of expenses are covered. Carefully plan for expenses given any usused funds will be forfeited following the pay year or extended claim period.