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Home   /   Flex Worksheet

  • Flex Worksheet


 

Use this easy calculator to see
how much money you will save.
Simply fill in the estimated amount on the items you wish to save for.
 

Healthcare
Expenses
(estimated)
Healthcare
(cont.)
Co-pays to doctors & pharmacies Oxygen, insulin, syringes & supplies
Over-the-counter drugs (except vitamins) Hearing aids, batteries & exams
Prescription drugs Artificial limbs & braces
Office visits & checkups Arches & orthopedic shoes
Prescribed sunglasses & eyeglasses Walkers, canes & wheelchairs
Contact lenses, solutions & supplies Physical & speech therapy
Eye exams, surgery & LASIK Weight loss program (prescribed by doctor)
Dental cleanings, fillings & x-rays Quit-smoking program & medications
Sealants, crowns, bridges & dentures Alcoholism & drug treatment
Braces, spacers, & retainers Medical Alert bracelet & fees
Wisdom teeth, implants & oral surgery Reconstructive surgery (birth defect, disease)
Psychologist & psychiatrist fees Wigs for hair loss caused by disease
Obstetrics & fertility Special school for disabled child
Lab tests & body scans Travel & mileage to doctor or hospital
Chiropractor & podiatrist fees
Dependent
Care Expenses
(estimated)
Nanny & babysitter thru age 12
Pre-K or nursery school
Before & after-school care thru age 12
Day camp thru age 12
Daycare for a disabled adult or child
Elder daycare for parent or dependent

Healthcare
Expenses
+
Dependent Expenses
=
Please
select your family’s income range:
YOU
SAVE
$
X
%
$

 

Health Choices
1605 Associates Drive
Dubuque, IA 52002
563-556-8070 | 800-747-8900
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