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