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Calculate Amount of Orthodontia Expense Which Can Be Reimbursed From FSA Account

The down payment for Orthodontia can be reimbursed up to the amount you elected for the plan year. Your down payment can only be reimbursed from the account that is active on the day the braces go on. Monthly payments can also be covered and can cross plan years. Reimbursement for monthly payments is based on the treatment plan agreements Truth in Lending statement using this formula. JavaScript must be enabled to use this calculator.

Pay periods	Every other week Every week Twice a month Monthly
Maximum allowable Medical Contribution	$
Date braces were applied	(mm/dd/yyyy)
Months of expected treatment
Treatment end date
Number of remaining payments
Number of payments in next plan year
Total treatment fee	$
Insurance lifetime benefit	$
Amount of initial down payment	$
Any discounts given	$
Total paid so far (include payments that will be made this year)	$

Patient responsibility	$
Remaining balance	$
Monthly payment	$

FSA contribution per pay period	$
Annual FSA contribution	$