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Re: Flex Spending Account enrollment
- To: noelle
- Subject: Re: Flex Spending Account enrollment
- From: Robert <http://dummy.us.eu.org/robert>
- Date: Mon, 12 Nov 2012 09:04:19 -0800
- Keywords: bogofilter, ifile: nonspam -1683.95661640 spam -2011.15144825 downloaded -2017.81405067 ---------, spambayes, spamprobe
No mammagrams or physicals?
> From: Noelle <http://dummy.us.eu.org/noelleg>
> Date: Mon, 12 Nov 2012 08:44:55 -0800 (PST)
>
> I don't need new glasses
> 2 dental co-pays and 1 medical co-pay
>
> On Mon, 12 Nov 2012, Robert wrote:
> > 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
> > > > $ 886__________ + 26_______________ = $ ________
> > > > 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