Re: Flex Spending Account enrollment

[Robert <http://dummy.us.eu.org/robert>]

What about eyeglasses?  Or dental co-pays?

 > From: Noelle <http://dummy.us.eu.org/noelleg>
 > Date: Mon, 12 Nov 2012 07:43:38 -0800 (PST)
 >
 > $90
 > On Tue, 6 Nov 2012, Robert wrote:
 > > Below are the numbers I have.  I think this is all I expect, unless I
 > > decide to get a physical exam.
 > > 
 > > Paychex
 > >  Flexible Spending Account
 > >  Deduction Worksheet
 > > NOTE: This is not an enrollment form. This worksheet is intended to guide
 > > you through the enrollment process.
 > >  This worksheet will help you calculate your applicable expenses and how
 > >  much money would be in an FSA deduction each pay period.
 > > 
 > >  Medical/Dental/Vision Reimbursement Account
 > >   Annual Medical Expenses, such as:
 > >   Deductibles and co-pays             $ _____________
 > >   Routine physical exams              $ _____________
 > >   Prescriptions                       $ _____________
 > >   Chiropractic care                   $ _____________
 > >   Other                               $ _____________
 > >  Annual Dental Expenses, such as:
 > >   Deductibles and co-pays             $ _____________
 > >   Routine check-ups                   $ __________140
 > >   Orthodontia                         $ _____________
 > >   Other                               $ _____________
 > >  Annual Vision Care Expenses, such as:
 > >   Exams                               $ ____________0
 > >   Eyeglasses                          $ __________300
 > >   Contact lenses, solutions, cleaners $ _____________
 > >   Other                               $ __________6
 > >  Total Estimated
 > >  Medical/Dental/Vision Expenses
 > >    $ _____________ + _________________  = $ __________
 > >      Annual Amount   # of Pay Periods*     Per Pay Period
 > >      (cannot exceed
 > >       company max.)
 > > 
 > >  *Weekly, 52 pay periods Biweekly, 26 pay periods Semimonthly,
 > >   24 pay periods Monthly, 12 pay periods
 > > 
 > >  FSA009 8/05