Attention: Recently, security researchers have identified vulnerabilities in the TLS 1.1 encryption used by most websites to secure information online. Starting Friday, December 15th, 2017, Allegiance will require users to utilize a web browser with TLS 1.2 or later enabled. These advanced protocols offer increased security for your health information. Please update your browser to a version that supports TLS 1.2 or later or to the most current version; older browsers will be unable to access Allegiance websites.

Health Flexible Spending Account (FSA) Worksheet

This worksheet can help you decide an appropriate election for a Health FSA and estimate the amount of your tax savings. List medical expenses you regularly experience and any additional expected medical expenses that will be incurred during the plan year. Medical bills, bank records, and Explanation of Benefits statements (EOBs) can be helpful in projecting future expenses. For detailed tax rate information, consult your tax advisor.


BE CONSERVATIVE!
Include in your estimate only amounts that you are confident will be incurred by you and your family during the plan year.
Estimate Your Monthly Out-Of-Pocket Health Expenses
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Contact Us: 1-877-424-3570
Hours: Monday-Friday 7:00 am -6:00 pm MST
Flex-inquire@askallegiance.com