| View Flexible Spending Account | First Lastname (Certificate #: 123456789) |
|---|
| Account Categories | Health Care | Grand Total |
| Effective Date | 01/01/2002 | |
| Target Amount | $1,500.00 | |
| Deposit Amount | $576.97 | $576.97 |
| Adjustments | ||
| Net paid/payable Prior | ||
| Claims Submitted | $308.99 | $308.99 |
| Claims Paid | $308.99 | $308.99 |
| Claims Payable | ||
| Claims NOT Payable | ||
| Future Limit | ||
| Exclusion Level | ||
| Exclusion Maximum | ||
| Amount Available | $1,191.01 |