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Flex Spending Accounts Programs
HCFSA > Program Savings Calculator

HCFSA Worksheet

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HEALTH CARE FLEXIBLE SPENDING ACCOUNT (HCFSA) PROGRAM SAVINGS CALCULATOR FOR PLAN YEAR 2014

- Enter the requested information below to calculate your HCFSA tax savings
- Use the TAB key or mouse to move within the worksheet
- Do not use the ENTER key as a way to navigate through this worksheet or to complete your calculation.

Number of Exemptions Claimed:

 Federal
 State
 City


Tax Status: 

 Single    Married


Your Gross Annual Income:

 


Are you in the Pension System?

 Yes    No

Annual Pension Contribution:

 


Enter Annual Health Insurance Premium:




Enter annual contribution to the Health Care Flexible Spending Account Program (maximum $2,500, including annual administrative fee up to $48):

 


If you participate in the Dependent Care Assistance Program, enter annual contribution (maximum $5,000, including annual administrative fee up to $48):

 


Enter annual contribution to the TDA Plans (457, 401k, 403b), including Deferral Acceleration for Retirement (DAR), if any:

 

Excluding DAR, is your annual contribution to any one of the TDA Plans equal to or more than 7.5% of your gross annual income?

 Yes     No


Enter annual After-Tax Deductions (MCU, Union Dues, Saving Bonds, Pension Loan, Child Support, etc.):

 

  
 

 

 

 

 

 

 

 

 

HCFSA SAVINGS

With HCFSA
Without HCFSA
YOUR GROSS ANNUAL INCOME: $ $
P

R

E

T

A

X

Pension Contribution:

Health Insurance Premium:

Annual amount for Health Care Flexible Spending Account Program Expenses:

    
Health Care Flexible Spending Account Program Administrative Fee:


Dependent Care Assistance Program annual contribution:

Deferred Compensation Plan annual contribution:

ADJUSTED GROSS INCOME: $ $
Federal Income Tax:

New York State Income Tax

New York City Income Tax

FICA Deductions

Medicare Deductions

After-Tax Cost of Health Care Expenses

  
After-Tax Deductions (MCU, Union Dues, Saving Bonds, Pension Loan, Child Support, etc.)

TAKE-HOME PAY
HCFSA TAX SAVINGS

Please Note: 1) This worksheet provides only estimates of tax information and should not be assumed to be tax advice. Be sure to consult a tax advisor to determine the appropriate tax advice for your financial situation.  2) This worksheet is not intended nor shall be construed as a guarantee of tax savings.

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