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Re: Flex Spending Account enrollment



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




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