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Reimbursement Services  >  Enrollment  >  Estimator

Enrollment Estimator  
 Medical Expenses YTD Claims New Amount
Deductibles $
Copayments $30.00 $
Prescription drugs $
Office visits $
Routine exams or physicals $
Chiropractor $
Surgery $
X-Ray / lab fees $
Birth control pills $
Smoking cessation programs $
Mileage to and from medical providers $
Hearing aids and batteries $
Psychiatrist and psychologist visits $
Over-the-counter medications or drugs $47.95 $
Other medical expenses $533.77 $
 Dental Expenses YTD Claims New Amount
Deductibles $21.00 $
Copayments $
Routine Exams $
Orthodontia $
Dentures $
Crowns, caps, bridges, root canals $
Fillings $
Teeth cleaning (not bleaching) $
Other dental expenses $
 Vision Expenses YTD Claims New Amount
Deductibles $
Copayments $
Eye exams $
Prescription glasses $
Prescription sunglasses $
Prescription contact lenses $
Contact lens supplies $
Lasik surgery / radial keratotomy $
Other vision expenses $
 Dependent Day Care Expenses YTD Claims New Amount
Day care centers $
Private child care providers $
After-school care $
Elder care $
Other dependent day care expenses $
 Private Insurance Expenses YTD Claims New Amount
Health insurance $
Dental insurance $
Vision insurance $
COBRA payments $
Medicare Part B $
Other private insurance expenses $
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